Individual provider Active NPI

Corey Merrill

  • Physician Assistant
  • Glenview, IL
National Provider Identifier
1386032308
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2401 Ravine Way
Suite 200
Glenview, IL 60025-7645
Phone
(847) 998-5680
NPI assigned
Dec 29, 2014
Last updated
Feb 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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 Primary

Addresses

Primary practice location

2401 Ravine Way
Suite 200
Glenview, IL 60025-7645

Mailing address

900 Rand Rd
Sutie 300
Des Plaines, IL 60016-2359
Phone (847) 324-3976

Other practice location 1

9850 Genesee Ave Ste 320
LA Jolla, CA 92037-1208
Phone (858) 554-1212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200206002548 CA Practitioner - Physician Assistant 9234455171 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, shared by 18 NPIs, 2,047 clinicians
Monica Perlman MD IncGroup PAC ID 8820035884, 357 clinicians
Eon Care Clinicians of Ca PCGroup PAC ID 9739609199, 5 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-1910
Phone (858) 657-7000

3737 Moraga Ave
Suite B103
San Diego, CA 92117-5352
Phone (858) 799-0855

3900 5TH Ave
Suite 110
San Diego, CA 92103-3122
Phone (858) 554-1212

4142 Adams Ave
Suite 102
San Diego, CA 92116-2593
Phone (858) 617-0717

6915 Flanders Dr
Suite D
San Diego, CA 92121-2987
Phone (240) 778-6164

9300 Campus Point Dr
La Jolla, CA 92037-1300
Phone (858) 657-7000

9350 Campus Point Dr
La Jolla, CA 92037-1300
Phone (858) 657-7000

9400 Campus Point Dr
La Jolla, CA 92093-1350
Phone (858) 657-7000

9415 Campus Point Dr
La Jolla, CA 92093-1350
Phone (858) 657-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Dec 22, 2019 Accepting new patients
Regents of the University of California CurrentSince Dec 22, 2019 Accepting new patients
Regents of the University of California CurrentSince Nov 1, 2021 Accepting new patients
UC San Diego Health - Rancho Family Medical Group Past Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

9850 Genesee Ave
Ste 320
La Jolla, CA 92037
Phone (858) 864-9800

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 9

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 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": "1419811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1386032308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD",
            "address_2": "SUTIE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162359",
            "telephone_number": "847-324-3976",
            "fax_number": "847-929-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 RAVINE WAY",
            "address_2": "SUITE 200",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257645",
            "telephone_number": "847-998-5680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9850 Genesee Ave Ste 320",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371208",
            "country_code": "US",
            "telephone_number": "858-554-1212",
            "fax_number": "858-795-1195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "COREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-29",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.