NPIMap

Individual provider Active NPI

Paul Antony Panzica, M.D.

  • Pediatrics Physician
  • Mokena, IL
National Provider Identifier
1295802882
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036095398 Issued in IL
Practice address
19621 La Grange Rd
Mokena, IL 60448-9360
Phone
(708) 478-8380
Fax
(708) 478-3036
NPI assigned
Nov 29, 2006
Last updated
Dec 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036095398 IL
Pediatrics Physician 208000000X 036095398 IL Primary

Addresses

Primary practice location

19621 La Grange Rd
Mokena, IL 60448-9360

Mailing address

19621 S la Grange Rd
Mokena, IL 60448-9360
Phone (708) 478-8380

Other identifiers 1

IdentifierTypeStateIssuer
036095398MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031125000242 IL Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Pediatric Medicine 4284538851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Internal Medicine, Pediatric Medicine
Education
Southern Illinois University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19621 S la Grange Rd
Mokena, IL 60448-9360
Phone (708) 478-8380

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036095398ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Adult & Pediatric Care, S.C. Internal Medicine CurrentSince Apr 8, 2011 Accepting new patients

Locations

19621 S La Grange Rd
Mokena, IL 60448
Phone (708) 465-4559

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EJFAAA/Endpoint/EJFAAA

Organizations & group practices 1

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.

Hospital & facility affiliations 7

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1295802882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19621 S LA GRANGE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489360",
            "telephone_number": "708-478-8380",
            "fax_number": "708-478-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19621 LA GRANGE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489360",
            "telephone_number": "708-478-8380",
            "fax_number": "708-478-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANZICA",
        "first_name": "PAUL",
        "middle_name": "ANTONY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095398",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036095398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095398",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

Verify at the official NPI Registry.