Individual provider Active NPI

Ruby Kaur Grover, PA-C

  • Physician Assistant
  • Norridge, IL
National Provider Identifier
1093167322
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.005874 Issued in IL
Practice address
4900 N Cumberland Ave
Norridge, IL 60706
Phone
(708) 456-1600
Fax
(708) 456-2809
NPI assigned
Jul 11, 2016
Last updated
Aug 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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 085.005874 IL Primary

Addresses

Primary practice location

4900 N Cumberland Ave
Norridge, IL 60706

Mailing address

3871 Melody St
Mundelein, IL 60060-6014
Phone (224) 456-7555

Other practice location 1

801 S Milwaukee Ave
Libertyville, IL 60048-3204
Phone (414) 290-6720

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
I20160817001471 IL Practitioner - Physician Assistant 0143515098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

1840 N Richmond Rd
McHenry, IL 60051-5416
Phone (779) 704-3075

416 S Milwaukee Ave
Libertyville, IL 60048-2821
Phone (847) 979-1112

4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.005874ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnow Urgent Care, PC CurrentSince Dec 20, 2024 Accepting new patients
Ihc-Libertyville Emergency Physicians, LLC Physician Assistant Past Accepting new patients
United Occupational Medicine and Walk in Services, LLC Physician Assistant Past Accepting new patients
Care at Home Physicians, LLC PastSince Jul 1, 2013 Accepting new patients

Locations

13448 Cicero Ave
Crestwood, IL 60418
Phone (708) 682-3384

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1093167322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3871 MELODY ST",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600606014",
            "telephone_number": "224-456-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 N CUMBERLAND AVE",
            "city": "NORRIDGE",
            "state": "IL",
            "postal_code": "60706",
            "telephone_number": "708-456-1600",
            "fax_number": "708-456-2809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 S Milwaukee Ave",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600483204",
            "country_code": "US",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROVER",
        "first_name": "RUBY",
        "middle_name": "KAUR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.005874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norridge, IL

Sources for this page

Verify at the official NPI Registry.