Individual provider Active NPI

Lawrence Wiggins, PA

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1104897974
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2361 Paysphere Cir
Chicago, IL 60674-0023
Phone
(847) 746-4358
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 Primary

Addresses

Primary practice location

2361 Paysphere Cir
Chicago, IL 60674-0023

Mailing address

2520 Elisha Ave
Zion, IL 60099-2676
Phone (847) 872-4561

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
I20040722000709 IL Practitioner - Physician Assistant 9234119058 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Waukegan Clinic CorpGroup PAC ID 4284631086, 60 clinicians

Practice addresses (Care Compare)

1616 Grand Ave
Suite a
Waukegan, IL 60085-3676
Phone (847) 249-1733

Hospital & facility affiliations

  • Vista Medical Center East Hospital, Waukegan, IL, CCN 140084

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oncology Hematology Associates of Northern Illinois, LTD CurrentSince Sep 1, 2025 Accepting new patients
Waukegan Clinic Corp CurrentSince Sep 1, 2025 Accepting new patients

Locations

15 Tower Ct
Ste 210
Gurnee, IL 60031
Phone (847) 599-1444

200 S Greenleaf St
Ste L
Gurnee, IL 60031
Phone (847) 360-7888

1616 Grand Ave
Ste A
Waukegan, IL 60085
Phone (847) 249-1733

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2069/brand/1/csg/29/fhir/r4
  • Direct secure messaging: lawrence.wiggins.1@2069.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104897974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 ELISHA AVE",
            "city": "ZION",
            "state": "IL",
            "postal_code": "600992676",
            "telephone_number": "847-872-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2361 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740023",
            "telephone_number": "847-746-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGGINS",
        "first_name": "LAWRENCE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.