Individual provider Active NPI

Mikaela Shapiro, PA-C

  • Physician Assistant
  • Plainfield, IL
National Provider Identifier
1497587414
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010210 Issued in IL
Practice address
24600 W 127TH St Ste 335
Plainfield, IL 60585-9558
Phone
(815) 676-6716
NPI assigned
Aug 19, 2024
Last updated
Oct 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 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 085010210 IL Primary

Addresses

Primary practice location

24600 W 127TH St Ste 335
Plainfield, IL 60585-9558

Mailing address

15 Parkway North Blvd Apt 248
Deerfield, IL 60015-2573

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
I20250224001880 IL Practitioner - Physician Assistant 4587184353 Reassigns benefits to 2 organizations

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
Navrow LLCGroup PAC ID 8921257254, 3 clinicians
Oak Dermatology LLCGroup PAC ID 7810256849, 17 clinicians

Practice addresses (Care Compare)

24600 W 127TH St
Building B Suite 335
Plainfield, IL 60585-9507
Phone (815) 676-6716

550 E Devon Ave
Suite 200
Itasca, IL 60143-2639
Phone (864) 625-3376

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085010210ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Dermatology LLC CurrentSince Jan 1, 2026 Accepting new patients

Locations

550 E Devon Ave
Ste 200
Itasca, IL 60143
Phone (864) 625-3376

24600 W 127th St
Bldg B
Plainfield, IL 60585
Phone (815) 267-8830

24600 W 127th St
Ste 335
Plainfield, IL 60585
Phone (815) 676-6716

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1497587414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PARKWAY NORTH BLVD APT 248",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600152573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24600 W 127TH ST STE 335",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605859558",
            "telephone_number": "815-676-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAPIRO",
        "first_name": "MIKAELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

Verify at the official NPI Registry.