NPIMap

Individual provider Active NPI

Brittany Waclaw, PA-C

  • Surgical Physician Assistant
  • Chicago, IL
National Provider Identifier
1174907646
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
085005504 Issued in IL
Practice address
3000 N Halsted St Ste 500
Chicago, IL 60657-5194
Phone
(773) 477-4343
NPI assigned
Jul 15, 2015
Last updated
Mar 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085005504 IL Primary

Addresses

Primary practice location

3000 N Halsted St Ste 500
Chicago, IL 60657-5194

Mailing address

2650 Warrenville Rd
Suite 280
Downers Grove, IL 60515-1748
Phone (630) 324-7900

Other practice location 1

3231 Euclid Ave
Suite 200
Berwyn, IL 60402-3471
Phone (708) 783-7025

Other names 1

  • Brittany Sims Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 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
I20150731015340 IL Practitioner - Physician Assistant 6305150566 Reassigns benefits to 1 organization
I20231101001117 WI Practitioner - Physician Assistant 6305150566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiac Surgery Associates SCGroup PAC ID 2860304102, 44 clinicians

Practice addresses (Care Compare)

155 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (331) 221-0274

1775 Dempster St
Park Ridge, IL 60068-1143
Phone (847) 723-5589

3 Eire CT
Oak Park, IL 60302-2519
Phone (708) 763-6477

3815 Highland Ave
Downers Grove, IL 60515-1500
Phone (630) 275-1318

7435 W Talcott Ave
Chicago, IL 60631-3707
Phone (773) 792-5172

801 S Washington St
Naperville, IL 60540-7430
Phone (630) 527-3083

836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 296-5577

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085005504ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Agnesian Healthcare Inc CurrentSince Sep 18, 2023 Accepting new patients
Agnesian Healthcare Inc CurrentSince Sep 18, 2023 Accepting new patients

Locations

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

Interoperability endpoints

  • Direct secure messaging: bsims59507@direct.edward.org
  • Direct secure messaging: bsims712852@direct.unitypoint.org

Organizations & group practices 5

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 3

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": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1174907646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 WARRENVILLE RD",
            "address_2": "SUITE 280",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151748",
            "telephone_number": "630-324-7900",
            "fax_number": "630-929-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N HALSTED ST STE 500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575194",
            "telephone_number": "773-477-4343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3231 Euclid Ave",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604023471",
            "country_code": "US",
            "telephone_number": "708-783-7025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WACLAW",
        "first_name": "BRITTANY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085005504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRITTANY",
            "last_name": "SIMS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.