Individual provider Active NPI

Emily Sherbin, PA-C

  • Physician Assistant
  • Lake Forest, IL
National Provider Identifier
1467769687
Registry record updated Aug 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.003750 Issued in IL
Practice address
660 N Westmoreland Rd
Lake Forest, IL 60045-1659
Phone
(847) 234-5600
NPI assigned
Sep 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085003750 IL
Physician Assistant 363A00000X 085.003750 IL Primary

Addresses

Primary practice location

660 N Westmoreland Rd
Lake Forest, IL 60045-1659

Mailing address

680 N Lake Shore Drive
Suite 1000
Chicago, IL 60611-8709
Phone (312) 695-0665

Other identifiers 1

IdentifierTypeStateIssuer
1091336OtherNCCPA

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
I20110208000382 IL Practitioner - Physician Assistant 5597945543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.003750ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Oct 1, 2010 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

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

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

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

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.

NPI Registry JSON

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

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502928000000",
    "number": "1467769687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 N LAKE SHORE DRIVE",
            "address_2": "SUITE 1000",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606118709",
            "telephone_number": "312-695-0665",
            "fax_number": "312-695-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451659",
            "telephone_number": "847-234-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERBIN",
        "first_name": "EMILY",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-09",
        "last_updated": "2017-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085003750",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.003750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1091336",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.