Lidia S Pomaville, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-004255 Issued in IL

Practice address

3253 S Harlem Ave
Suite 1a
Berwyn, IL 60402-3073

Phone

(262) 898-4400

Fax

(708) 788-6884

NPI assigned

Mar 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lidia Schettle Former name

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Crest Hill, IL
  • NPI 1053783308
  Medicare reassignment Care Compare group NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Medical Surgical Dermatology, SC

  • Specialist
  • Berwyn, IL
  • NPI 1316014723
  NPD (past)
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1144595174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "866-630-9882",
            "fax_number": "920-682-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3253 S HARLEM AVE",
            "address_2": "SUITE 1A",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023073",
            "telephone_number": "262-898-4400",
            "fax_number": "708-788-6884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMAVILLE",
        "first_name": "LIDIA",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-08",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-004255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lidia.pomaville@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "3253 S Harlem Ave",
            "address_2": "Suite 1A",
            "city": "Berwyn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604023073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LIDIA",
            "last_name": "SCHETTLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pinnacle Healthcare of Berwyn
• Eduardo Pinon
• Nancy Pinto, BA
• Dan Joseph Pioletti, LCSW
• Kavya Bindu Poluru, MD
• Amudha Porchezhian, MD
• Valderes Pou, BSW
• Precision Dental, LTD.
• Premier Pain Specialists LLC
• Jerry L Price Jr., MBA

• Physician Assistant in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.