NPIMap

Individual provider Active NPI

Andrew J Donofrio, PA-C

  • Physician Assistant
  • Kankakee, IL
National Provider Identifier
1124546221
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110010078 Issued in VA
Practice address
500 N Wall St
Kankakee, IL 60901-2942
Phone
(844) 404-4787
Fax
(815) 936-3243
NPI assigned
Sep 8, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085006333 IL
Physician Assistant 363A00000X 0110010078 VA Primary

Addresses

Primary practice location

500 N Wall St
Kankakee, IL 60901-2942

Mailing address

500 N Wall St
Kankakee, IL 60901-2942
Phone (844) 404-4787

Other practice location 1

515 NE Glen Oak Ave
Peoria, IL 61603-3136
Phone (309) 674-2002

Other practice location 2

2006 Health Campus Dr Fl 2
Rockingham, VA 22801-8679
Phone (540) 689-5555

Other names 1

  • Mr. Andrew Joseph Donofrio Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adonofrio28364@Direct.riversidehealthcare.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO, VA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20171023002465 IL Practitioner - Physician Assistant 4587930383 Reassigns benefits to 2 organizations
I20211102000730 MO Practitioner - Physician Assistant 4587930383 Reassigns benefits to 4 organizations
I20240927000812 VA Practitioner - Physician Assistant 4587930383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritas Health CorporationGroup PAC ID 6305748153, 492 clinicians

Practice addresses (Care Compare)

2800 Clay Edwards Dr
North Kansas City, MO 64116-3220
Phone (816) 691-2021

9411 N Oak Trfy
Suite 260
Kansas City, MO 64155-2281
Phone (816) 221-6750

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085006333ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Apr 2, 2024 Accepting new patients
Meritas Health Corporation CurrentSince Nov 1, 2021 Accepting new patients
Meritas Health Corporation CurrentSince Nov 1, 2021 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 2, 2024 Accepting new patients
SSM Medical Group, Inc. CurrentSince Nov 1, 2022 Accepting new patients
RMH Medical Group LLC CurrentSince Jun 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 2, 2024 Accepting new patients
Riverside Health System CurrentSince Aug 26, 2019 Accepting new patients
SSM Medical Group Inc. CurrentSince Nov 1, 2022 Accepting new patients
Rockingham Memorial Hospital Past Accepting new patients
Sentara RMH Medical Center Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

500 N Wall St
Kankakee, IL 60901
Phone (815) 937-9300

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

9411 N Oak Trfy
Ste 260
Kansas City, MO 64155
Phone (816) 453-4000

2700 Clay Edwards Dr
Ste 240
North Kansas City, MO 64116
Phone (816) 455-0681

2790 Clay Edwards Dr
Ste 520B
North Kansas City, MO 64116
Phone (816) 691-5198

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

136 W Elizabeth St
Ste 201
Harrisonburg, VA 22802
Phone (540) 564-5104

2006 Health Campus Dr
Ste 200
Rockingham, VA 22801
Phone (540) 689-5555

Interoperability endpoints

  • Direct secure messaging: adonofrio973532@direct.sentara.net
  • Direct secure messaging: adonofrio28364@direct.riversidehealthcare.net

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 4

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": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1124546221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012942",
            "telephone_number": "844-404-4787",
            "fax_number": "815-936-3243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 NE Glen Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616033136",
            "country_code": "US",
            "telephone_number": "309-674-2002",
            "fax_number": "309-624-8949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2006 Health Campus Dr Fl 2",
            "address_purpose": "LOCATION",
            "city": "Rockingham",
            "state": "VA",
            "postal_code": "228018679",
            "country_code": "US",
            "telephone_number": "540-689-5555",
            "fax_number": "757-579-8607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONOFRIO",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-08",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006333",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adonofrio28364@Direct.riversidehealthcare.net",
            "affiliation": "N",
            "endpointDescription": "Direct Secure address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 N Wall St",
            "city": "Kankakee",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609012942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANDREW",
            "last_name": "DONOFRIO",
            "middle_name": "JOSEPH",
            "prefix": "MR.",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.