Individual provider Active NPI

Ruth Lorena Serrano

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1194457861
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-010805 Issued in IL
Practice address
240 E Huron St Ste 1-200
Chicago, IL 60611-2909
Phone
(312) 503-1851
NPI assigned
Jun 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IL
Physician Assistant 363A00000X 085-010805 IL Primary

Addresses

Primary practice location

240 E Huron St Ste 1-200
Chicago, IL 60611-2909

Mailing address

240 E Huron St Ste 1-200
Chicago, IL 60611-2909
Phone (312) 503-1851

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
I20250117000501 IL Practitioner - Physician Assistant 2264960343 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085-010805ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County CurrentSince Dec 11, 2024 Accepting new patients
Cook County CurrentSince Dec 11, 2024 Accepting new patients

Locations

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

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.

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1194457861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 E HURON ST STE 1-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112909",
            "telephone_number": "312-503-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 E HURON ST STE 1-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112909",
            "telephone_number": "312-503-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO",
        "first_name": "RUTH",
        "middle_name": "LORENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-30",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-010805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.