Carrie S Fortman, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085001080 Issued in IL

Practice address

1600 N Randall Rd
Elgin, IL 60123

Phone

(847) 214-5100

Fax

(847) 289-5579

NPI assigned

Nov 14, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Dupage Internal Medicine, LTD.

  • Endocrinology, Diabetes & Metabolism Physician
  • Carol Stream, IL
  • NPI 1295865079

  Internal Medicine

  NPD

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1336211549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237803",
            "telephone_number": "847-214-5100",
            "fax_number": "847-289-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "60123",
            "telephone_number": "847-214-5100",
            "fax_number": "847-289-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTMAN",
        "first_name": "CARRIE",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "F400138108",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Forever Care Home Care LLC
• Sofia Forke
• Amy Forsberg, PA-C
• Kirstie Lynn Forst, PHARMD
• Janet Carol Fortier, PHARMD
• Fortress Dental Corporation
• Deborah Foshager, LPC
• Danille D. Fossie
• Bethany Foster
• Regina Foster, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.