Individual provider Active NPI

Annie Zupan, PA-C

  • Physician Assistant
  • Skokie, IL
National Provider Identifier
1346888989
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007157 Issued in IL
Practice address
9977 Woods Dr
Skokie, IL 60077-1057
Phone
(224) 364-2273
NPI assigned
Dec 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.007157 IL Primary

Addresses

Primary practice location

9977 Woods Dr
Skokie, IL 60077-1057

Mailing address

9977 Woods Dr
Skokie, IL 60077-1057
Phone (224) 364-2273

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address azupan274404@direct.northshore.org

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
I20200110002554 IL Practitioner - Physician Assistant 3678908134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

211 Waukegan Rd
Suite 200
Northfield, IL 60093-2724
Phone (847) 767-3718

2323 W Lawrence Ave
Chicago, IL 60625-1913
Phone (224) 364-2273

2650 Ridge Ave
Evanston, IL 60201-1700

3122 N Ashland Ave
Chicago, IL 60657-3014
Phone (773) 687-0999

4901 Searle Pkwy
Suite 150
Skokie, IL 60077-1057

4914 N Clark St
Chicago, IL 60640-3515
Phone (224) 364-2273

501 Skokie Blvd
Northbrook, IL 60062-2802
Phone (847) 504-2300

5238 N Broadway St
Chicago, IL 60640-2304
Phone (224) 364-2273

524 Main St
Evanston, IL 60202-1815
Phone (224) 364-2273

6071 N Lincoln Ave
Chicago, IL 60659-2435
Phone (224) 364-2273

6450 W Touhy Ave
Niles, IL 60714-4512

71 Waukegan Rd
Suite 700
Lake Bluff, IL 60044-1614
Phone (224) 364-2273

9977 Woods Dr
Skokie, IL 60077-1057
Phone (847) 663-8062

9977 Woods Dr 2ND Floor
Skokie, IL 60077-1057
Phone (847) 663-8370

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085.007157ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jan 1, 2020 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

9977 Woods Dr
Skokie, IL 60077
Phone (847) 663-8540

Interoperability endpoints

  • Direct secure messaging: azupan274404@direct.northshore.org

Organizations & group practices 2

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": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1346888989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "224-364-2273",
            "fax_number": "847-663-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "224-364-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUPAN",
        "first_name": "ANNIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "azupan274404@direct.northshore.org",
            "affiliation": "N",
            "address_1": "9977 Woods Dr",
            "city": "Skokie",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600771057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.