Ismene Potakis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085004104 Issued in IL

Practice address

675 N Saint Clair St Ste 14-200
Chicago, IL 60611-5966

Phone

(126) 957-5423

Fax

(312) 695-5462

NPI assigned

Aug 23, 2011

Last updated

Aug 24, 2021By the provider in NPPES

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

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

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• A-1 Medical Imaging

  • Radiology Clinic/Center
  • Melrose Park, IL
  • NPI 1669678264
  NPD (past)
• Center for Women

  • Obstetrics & Gynecology Physician
  • Melrose Park, IL
  • NPI 1063502813
  NPD (past)
• Central Dupage Physician Group

  dba Northwestern Medicine Regional Medical Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1215217286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 14-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115966",
            "telephone_number": "312-695-7542",
            "fax_number": "126-955-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 14-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115966",
            "telephone_number": "126-957-5423",
            "fax_number": "312-695-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTAKIS",
        "first_name": "ISMENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-23",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgette Ladell Poston, MSW, LCSW
• Jason Poston
• Lindsay Poston, MD
• Zoe Postula, MS CCC-SLP
• Joseph Gerard Potaczek, PSY.D.
• Nivedita Ravi Potapragada
• Edward John Potash, M.D.
• Steven R Potashnick, D.D.S.
• Lindsey Anne Pote, PHARM.D.
• Courtney Potempa, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.