NPIMap

Individual provider Active NPI

Alexis C Alvarado, PA-C

  • Medical Physician Assistant
  • Merillville, IL
National Provider Identifier
1174861090
Registry record updated Nov 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10001662A Issued in IN
Practice address
8687 Connecticut St
Ste D
Merillville, IL 46410-5541
Phone
(219) 750-9630
Fax
(219) 750-9451
NPI assigned
Jan 28, 2013
Last updated
Nov 6, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085-004592 IL
Medical Physician Assistant 363AM0700X 10001662A IN Primary

Addresses

Primary practice location

8687 Connecticut St
Ste D
Merillville, IL 46410-5541

Mailing address

8687 Connecticut St
Ste D
Merillville, IL 46410-5541
Phone (219) 750-9630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20130419000130 IL Practitioner - Physician Assistant 5799921664 Reassigns benefits to 1 organization
I20151104003102 IN Practitioner - Physician Assistant 5799921664

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Chicago Spine and Joint, S.C.Group PAC ID 1153374038, 9 clinicians

Practice addresses (Care Compare)

1890 Silver Cross Blvd
New Lenox, IL 60451-9524
Phone (815) 416-1224

907 N Elm St
Suite 101
Hinsdale, IL 60521-3644
Phone (708) 482-4500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-004592ILMDMedical Physician Assistant
10001662AINMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Suburban Urology Associates SC Past Accepting new patients
Chicago Spine and Joint, S.C. Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446768000000",
    "number": "1174861090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8687 CONNECTICUT ST",
            "address_2": "STE D",
            "city": "MERILLVILLE",
            "state": "IL",
            "postal_code": "464105541",
            "telephone_number": "219-750-9630",
            "fax_number": "219-750-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8687 CONNECTICUT ST",
            "address_2": "STE D",
            "city": "MERILLVILLE",
            "state": "IL",
            "postal_code": "464105541",
            "telephone_number": "219-750-9630",
            "fax_number": "219-750-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALVARADO",
        "first_name": "ALEXIS",
        "middle_name": "C",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-28",
        "last_updated": "2015-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-004592",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10001662A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.