Active NPI
Alexis Bertumen Navares, PHYSICIAN ASSISTANT
- Physician Assistant
- Lake Bluff, IL
National Provider Identifier
1265606131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 238000160
- Practice address
- 655 Rockland Rd
Ste 206
Lake Bluff, IL 60044 - Phone
- (847) 283-0720
- Fax
- (847) 283-0723
- NPI assigned
- Apr 22, 2008
- 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 | 238000160 | IL | Primary |
Addresses
Primary practice location
655 Rockland Rd
Ste 206
Lake Bluff, IL 60044
Mailing address
2400 Michael Ave
Zion, IL 60099
Phone (847) 917-9197
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238000160 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208822400000",
"number": "1265606131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 MICHAEL AVE",
"city": "ZION",
"state": "IL",
"postal_code": "60099",
"telephone_number": "847-917-9197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 ROCKLAND RD",
"address_2": "STE 206",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "60044",
"telephone_number": "847-283-0720",
"fax_number": "847-283-0723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAVARES",
"first_name": "ALEXIS",
"middle_name": "BERTUMEN",
"name_prefix": "Mr.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-22",
"last_updated": "2008-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "238000160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Bluff, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.