Individual provider Active NPI

Andrea Alexis Guzman, PA-C

  • Physician Assistant
  • Palos Heights, IL
National Provider Identifier
1467214726
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
12255 S 80TH Ave Ste 204
Palos Heights, IL 60463-1284
Phone
(708) 923-4400
Fax
(708) 923-4295
NPI assigned
Jan 23, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

12255 S 80TH Ave Ste 204
Palos Heights, IL 60463-1284

Mailing address

12255 S 80TH Ave Ste 204
Palos Heights, IL 60463-1284
Phone (708) 923-4400

Other practice location 1

3127 Maple Ave
Brookfield, IL 60513-1236
Phone (708) 712-8677

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
I20240409003366 IL Practitioner - Physician Assistant 3375981483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

12251 S 80TH Ave
Palos Heights, IL 60463-1290
Phone (708) 923-5869

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Mar 17, 2024 Accepting new patients

Locations

12255 S 80th Ave
Ste 204
Palos Heights, IL 60463
Phone (708) 923-4400

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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 2

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": "1705968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1467214726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 S 80TH AVE STE 204",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631284",
            "telephone_number": "708-923-4400",
            "fax_number": "708-923-4295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 S 80TH AVE STE 204",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631284",
            "telephone_number": "708-923-4400",
            "fax_number": "708-923-4295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3127 Maple Ave",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "IL",
            "postal_code": "605131236",
            "country_code": "US",
            "telephone_number": "708-712-8677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUZMAN",
        "first_name": "ANDREA",
        "middle_name": "ALEXIS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.