Individual provider Active NPI

Korinne Mae Lusterio, PA-C

  • Physician Assistant
  • Huntley, IL
National Provider Identifier
1265862874
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009398 Issued in IL
Practice address
10400 Haligus Rd
Huntley, IL 60142-9553
Phone
(224) 654-0100
Fax
(224) 654-0105
NPI assigned
Nov 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 085009398 IL Primary

Addresses

Primary practice location

10400 Haligus Rd
Huntley, IL 60142-9553

Mailing address

10400 Haligus Rd
Huntley, IL 60142-9553
Phone (224) 654-0100

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
I20230118002230 IL Practitioner - Physician Assistant 7719117886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
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)

10400 Haligus Rd
Huntley, IL 60142-9553

4309 W Medical Ctr Dr
Suite A200
McHenry, IL 60050-8437
Phone (815) 759-8070

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

Hospital & facility affiliations

  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jan 6, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jan 6, 2023 Accepting new patients
Observation Medicine Physicians of Champaign County, LTD Past Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Emergency Medicine Physicians of Hamilton County, LTD. Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

10400 Haligus Rd
Huntley, IL 60142
Phone (224) 654-0000

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

3701 Doty Rd
Woodstock, IL 60098
Phone (815) 334-3170

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1265862874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 HALIGUS RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429553",
            "telephone_number": "224-654-0100",
            "fax_number": "224-654-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 HALIGUS RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429553",
            "telephone_number": "224-654-0100",
            "fax_number": "224-654-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTERIO",
        "first_name": "KORINNE MAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-18",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntley, IL

Sources for this page

Verify at the official NPI Registry.