Brian B Minardi, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085.004739 Issued in IL

Practice address

2615 Harrison St
Bellwood, IL 60104-2450

Phone

(708) 493-0299

Fax

(708) 493-0594

NPI assigned

Aug 13, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Physicians Immediate Care North Chicago LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1205814118
  Medicare reassignment

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1104259126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 HARRISON ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042450",
            "telephone_number": "708-493-0299",
            "fax_number": "708-493-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 HARRISON ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042450",
            "telephone_number": "708-493-0299",
            "fax_number": "708-493-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINARDI",
        "first_name": "BRIAN",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.004739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Huma Masood, M.D
• Joe Mattingly, ATC
• Alexandra Nicole McDonald
• Med Spa for Me, Inc. (Johnson-Miller Funeral Chapel, PC)
• Mila Medical Supply LLC
• Alexia Montino
• Corrina Morris
• James Morris III
• Sethurama Muthuramaswami, DDS
• Nora Myers, CRSS

• Medical Physician Assistant in Bellwood, IL
• Providers in Bellwood, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.