Individual provider Active NPI

Alisyn Nicole Ostrom, PA-C

  • Physician Assistant
  • Palos Hills, IL
National Provider Identifier
1508693839
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-010866 Issued in IL
Practice address
10330 S Roberts Rd
Palos Hills, IL 60465-1971
Phone
(708) 237-7200
Fax
(708) 237-7201
NPI assigned
Sep 19, 2024
Last updated
Jan 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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 085-010866 IL Primary

Addresses

Primary practice location

10330 S Roberts Rd
Palos Hills, IL 60465-1971

Mailing address

10330 S Roberts Rd
Palos Hills, IL 60465-1971
Phone (708) 237-7200

Other practice location 1

19065 Hickory Creek Dr Ste 210
Mokena, IL 60448-8597
Phone (708) 237-7200

Other identifiers 1

IdentifierTypeStateIssuer
085-010866OtherILPA LICENSE

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
I20241014004062 IL Practitioner - Physician Assistant 4385176478 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-010866ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Midamerica Orthopaedics, S.C. CurrentSince Sep 30, 2024 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

19065 Hickory Creek Dr
Ste 210
Mokena, IL 60448
Phone (708) 237-7200

10330 S Roberts Rd
Palos Hills, IL 60465
Phone (708) 237-7200

Interoperability endpoints

  • Direct secure messaging: aostrom@mo1800.srs-direct.com

Organizations & group practices 3

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": "1726704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1508693839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651971",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 S ROBERTS RD",
            "city": "PALOS HILLS",
            "state": "IL",
            "postal_code": "604651971",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19065 Hickory Creek Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488597",
            "country_code": "US",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSTROM",
        "first_name": "ALISYN",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-19",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-010866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "085-010866",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Hills, IL

Sources for this page

Verify at the official NPI Registry.