Individual provider Active NPI

Kristina Regina Gaspers, PA-C

  • Physician Assistant
  • Plainfield, IL
National Provider Identifier
1093015448
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085003877 Issued in IL
Practice address
16519 S Rte 59
Plainfield, IL 60586-2606
Phone
(630) 646-5020
Fax
(630) 646-5025
NPI assigned
Nov 1, 2010
Last updated
Sep 20, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003877 IL Primary

Addresses

Primary practice location

16519 S Rte 59
Plainfield, IL 60586-2606

Mailing address

16519 S Rte 59
Plainfield, IL 60586-2606
Phone (630) 646-5020

Other names 1

  • Kristina Regina Mallen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000479 IL Practitioner - Physician Assistant 1850589763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2205 Butterfield Rd
Downers Grove, IL 60515-1157
Phone (630) 527-3645

2650 Ridge Ave
Evanston, IL 60201-1700

2855 95TH St
Naperville, IL 60564-9011
Phone (630) 527-3645

755 N York St
Elmhurst, IL 60126-1607
Phone (331) 221-2900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085003877ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Health Ventures Physician Assistant CurrentSince Apr 6, 2017 Accepting new patients
Edward Health Ventures CurrentSince Apr 6, 2017 Accepting new patients
Endeavor Health Medical Group Past Accepting new patients
Fastrac Medical, P.C. Past Accepting new patients

Locations

120 Spalding Dr
Ste 101
Naperville, IL 60540
Phone (630) 527-7730

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

16519 S Route 59
Plainfield, IL 60586
Phone (630) 646-5020

24600 W 127th St
Ste B100
Plainfield, IL 60585
Phone (815) 731-9000

Interoperability endpoints

  • Direct secure messaging: kgaspers127534@direct.edward.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474329600000",
    "number": "1093015448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16519 S RTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605862606",
            "telephone_number": "630-646-5020",
            "fax_number": "630-646-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16519 S RTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605862606",
            "telephone_number": "630-646-5020",
            "fax_number": "630-646-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASPERS",
        "first_name": "KRISTINA",
        "middle_name": "REGINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-01",
        "last_updated": "2016-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "MALLEN",
            "middle_name": "REGINA",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plainfield, IL

Sources for this page

Verify at the official NPI Registry.