Active NPI
Raymond E Hines III, PA-C
- Physician Assistant
- Mokena, IL
National Provider Identifier
1265524839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085000929
- Practice address
- 19110 Darvin Dr
Suite C
Mokena, IL 60448-8595 - Phone
- (708) 390-2290
- Fax
- (708) 390-2299
- NPI assigned
- Sep 29, 2006
- Last updated
- Mar 19, 2010
- 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 | 085000929 | IL | Primary |
Addresses
Primary practice location
19110 Darvin Dr
Suite C
Mokena, IL 60448-8595
Mailing address
19110 Darvin Dr
Suite C
Mokena, IL 60448-8595
Phone (708) 390-2290
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO9194 | Other | IL | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085000929 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268956800000",
"number": "1265524839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19110 DARVIN DR",
"address_2": "SUITE C",
"city": "MOKENA",
"state": "IL",
"postal_code": "604488595",
"telephone_number": "708-390-2290",
"fax_number": "708-390-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19110 DARVIN DR",
"address_2": "SUITE C",
"city": "MOKENA",
"state": "IL",
"postal_code": "604488595",
"telephone_number": "708-390-2290",
"fax_number": "708-390-2299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HINES",
"first_name": "RAYMOND",
"middle_name": "E",
"name_suffix": "III",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2010-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085000929",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "DO9194",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.