Michael De Venecia, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085009622 Issued in IL

Practice address

841 Broadmeadow Rd
Rantoul, IL 61866-2166

Phone

(217) 282-3010

NPI assigned

Apr 6, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Little Company of Mary Medical Center Hospital, Evergreen Park, IL, CCN 140179

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Osf Healthcare System

  • General Acute Care Hospital
  • Evergreen Park, IL
  • NPI 1215572045
  Care Compare affiliation

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

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1457046351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 YALOW DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618221140",
            "telephone_number": "618-843-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 BROADMEADOW RD",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "618662166",
            "telephone_number": "217-282-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VENECIA",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Health Partnership of Illinois
• Krista Nichole Covert, NP-C
• Kristan Creel
• Alexa Crossman
• Cunningham Children'S Home of Urbana Il
• Maureen Dickman, M.S. CCC-SLP
• Jacob Ediba
• Educational SVC Region Office
• Empowerme Rehabilitation Illinois, LLC
• Danielle Marie Faber, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.