Active NPI
Terrence P. Donovan, P.A.-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1215095997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-002034
- Practice address
- 1501 S California Ave
Chicago, IL 60608-1732 - Phone
- (773) 257-6770
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-002034 | IL | Primary |
Addresses
Primary practice location
1501 S California Ave
Chicago, IL 60608-1732
Mailing address
5455 N Sheridan Rd
Chicago, IL 60640-1958
Phone (773) 398-1656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085-002034 | Other | IL | STATE LICENSE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230530001237 | IL | Practitioner - Physician Assistant | 1153560917 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cook County
Practice addresses (Care Compare)
500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000
Hospital & facility affiliations
- John H Stroger Jr Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.11 of 100
- Quality
- 74.7
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 85.45
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-002034 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook County | Current | Accepting new patients | |
| Cook County | Current | Accepting new patients | |
| John H Stroger Jr Hospital Cook County | Past | Accepting new patients |
Locations
2424 S Pulaski Rd
Chicago, IL 60623
Phone (773) 257-8339
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 7
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.
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Hospital & facility affiliations 27
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": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231113600000",
"number": "1215095997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5455 N SHERIDAN RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401958",
"telephone_number": "773-398-1656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S CALIFORNIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081732",
"telephone_number": "773-257-6770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "TERRENCE",
"middle_name": "P.",
"name_prefix": "Mr.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2009-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-002034",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "085-002034",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; 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.