Dusty J Goodman
Individual provider Active NPI Physician Assistant · Glenview, IL
NPI 1366867640 · NPPES record last updated Jul 29, 2019
Key facts
- NPI
- 1366867640
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 2401 Ravine Way Ste 200
Glenview, IL 60025-7645 - Phone
- (847) 998-5680
- Fax
- (847) 998-6365
- NPI assigned
- Feb 24, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Alabama School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Illinois Bone and Joint Institute, LLC
Practice addresses (Care Compare)
2101 Waukegan Rd
Bannockburn, IL 60015-1836
2401 Ravine Way
Glenview, IL 60025-7645
9600 Gross Point Rd
Skokie, IL 60076-1214
Phone (847) 677-9600
Hospital & facility affiliations
- Northshore University Healthsystem - Evanston Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.07 of 100
- Quality
- 76.54
- Promoting interoperability
- 83
- Improvement activities
- 40
- Cost
- 74.52
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 |
|---|---|---|---|---|
| I20190924001167 | IL | Practitioner - Physician Assistant | 3072744952 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Bone and Joint Institute LLC | Current |
Accepting new patients | |
| Illinois Bone and Joint Institute, LLC | Current |
Accepting new patients | |
| HH Health System - the Orthopaedic Center, LLC | Past |
Accepting new patients |
Locations
2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096
5057 Paysphere Cir
Chicago, IL 60674
900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090
2401 Ravine Way
Ste 200
Glenview, IL 60025
Phone (847) 998-5680
521 Green Bay Rd
Wilmette, IL 60091
Phone (847) 724-4864
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/fca878a1-6c97-4ecb-b6e7-eb5d7cde15ab/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
2401 Ravine Way Ste 200
Glenview, IL 60025-7645
Mailing address
900 Rand Rd Ste 300
Des Plaines, IL 60016-2359
Phone (847) 324-3976
Other providers in Glenview, IL
- Daniel Jordan Gonzales Jr.
- Angela Gonzalez
- Bianca A Gonzalez
- Erin Jacquelin Gonzalez
- Rachel Goode
- Paul L. Goodman
- Quinn Goodwin
- Tanya Ann Goralczyk
- Amanda Gordon
- Debra Ann Gordon
All providers in Glenview, 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 Jul 29, 2019. 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.