Ann Walsh

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-008629 Issued in IL

Practice address

720 Florsheim Dr
Libertyville, IL 60048-3757

Phone

(847) 247-4000

Fax

(847) 234-2090

NPI assigned

Feb 18, 2019

Reactivated

Aug 11, 2021

Sex

Female

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 AZ

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner - University Physician Specialists LLCGroup PAC ID 5991008054, 343 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002

Merit-based Incentive Payment System (MIPS)

Final score

81.07 of 100Reported as group

Quality

76.54

Promoting interoperability

83

Improvement activities

40

Cost

74.52

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Banner - University Physician Specialists LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1437529245
  Medicare reassignment Care Compare group NPD
• Banner - University Physician Specialists LLC

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1164255865
  NPD
• KGH Consultation & Treatment, Inc.

  • Behavior Analyst
  • Deerfield, IL
  • NPI 1073840740

  Behavior Technician

  NPD (past)

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

• Banner - University Medical Center Phoenix

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1841224870
  Care Compare affiliation

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

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1487110219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD STE 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": "720 FLORSHEIM DR",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483757",
            "telephone_number": "847-247-4000",
            "fax_number": "847-234-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-18",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "deactivation_date": "2021-07-28",
        "reactivation_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "RBT019-74946",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-008629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Wagner, LCSW
• Jacylyn Denise Wahl, MPAS, PA-C
• Waldemar Mysiak MD SC
• Walgreen Co
• Walgreen Co
• Lisa Walsh
• Walter P Duzey DC PC
• Amy Lynn Walther, APNP
• Jonathan Walton, L. AC.
• Sam Wang, DC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.