Marcus Laron Forward II, PA-C
Individual provider Active NPI Physician Assistant · Norridge, IL
NPI 1336767292 · NPPES record last updated Mar 4, 2022
Key facts
- NPI
- 1336767292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085008479 (IL)
- Practice address
- 4900 N Cumberland Ave
Norridge, IL 60706-2901 - Phone
- (708) 456-1600
- NPI assigned
- Jul 8, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University of Chicago
Practice addresses (Care Compare)
5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200
Hospital & facility affiliations
- The University of Chicago Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211222002577 | IL | Practitioner - Physician Assistant | 7214328491 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The University of Chicago Medical Center | Current |
Accepting new patients | |
| The University of Chicago Medical Center | Current |
Accepting new patients | |
| Mind Revival Psych Inc | Past |
Accepting new patients |
Locations
150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061
Interoperability endpoints
- marcus.forward.1@3342.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 085008479 | IL | Yes |
Addresses
Primary practice location
4900 N Cumberland Ave
Norridge, IL 60706-2901
Mailing address
2003 W Fulton St # 303
Chicago, IL 60612-2345
Phone (312) 243-2223
Other practice location 1
2003 W Fulton St # 303
Chicago, IL 60612-2345
Phone (123) 243-2223
Other providers in Norridge, IL
- Richard Steven Ferdman
- Finnegan Family Chiropractic LTD
- First Therapy Services PC
- Five Star Pharmacy LLC
- Flexible Behavioral Solutions
- Fresenius Medical Care Chicagoland, LLC
- Bruce Fuggiti
- Gabachief Medical Inc
- Jay Gandhi
- GCMD, Inc
All providers in Norridge, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.