Individual provider Active NPI

Angela Marie Shaw, PA-C

  • Physician Assistant
  • Burr Ridge, IL
National Provider Identifier
1518466077
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.006507 Issued in IL
Practice address
901 McClintock Dr Ste 201
Burr Ridge, IL 60527-0872
Phone
(888) 220-6432
NPI assigned
Feb 9, 2018
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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 085.006507 IL Primary

Addresses

Primary practice location

901 McClintock Dr Ste 201
Burr Ridge, IL 60527-0872

Mailing address

901 McClintock Dr Ste 201
Burr Ridge, IL 60527-0872
Phone (630) 933-5518

Other names 1

  • Miss Angela Marie Grano Former name

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
I20180724001316 IL Practitioner - Physician Assistant 0244587129 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

400 Remington Blvd
Bolingbrook, IL 60440-4923
Phone (630) 312-7865

901 McClintock Dr
Burr Ridge, IL 60527-0872
Phone (888) 220-6432

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.006507ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group CurrentSince Oct 1, 2020 Accepting new patients
Metro Infectious Disease Consultants, LLC CurrentSince Feb 7, 2022 Accepting new patients
Metro Infectious Disease Consultants LLC CurrentSince Feb 7, 2022 Accepting new patients
Rush University Medical Center CurrentSince Oct 1, 2020 Accepting new patients

Locations

400 Remington Blvd
Bolingbrook, IL 60440
Phone (630) 226-8100

901 McClintock Dr
Ste 201
Burr Ridge, IL 60527
Phone (630) 654-4201

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

310 W Plaza Dr
Carterville, IL 62918
Phone (618) 525-0719

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

600 S Paulina St
Ste 140
Chicago, IL 60612
Phone (312) 942-5865

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1435 N Randall Rd
Ste 404
Elgin, IL 60123
Phone (847) 741-5091

1300 Franklin Ave
Ste 230C
Normal, IL 61761
Phone (309) 585-6029

25 N Winfield Rd
Ste 507
Winfield, IL 60190
Phone (630) 933-5518

Interoperability endpoints

  • Direct secure messaging: ashaw120299@direct.rush.rush-health.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1518466077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR STE 201",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "630-933-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR STE 201",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270872",
            "telephone_number": "888-220-6432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GRANO",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Burr Ridge, IL

Sources for this page

Verify at the official NPI Registry.