Ellen Slade, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009218 Issued in MI

Practice address

2875 W 19TH St
Chicago, IL 60623-3501

Phone

(313) 533-5002

NPI assigned

Jan 8, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Humboldt Park Health Emergency Medicine, LLC

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1104592120
  Medicare reassignment
• St Anthony Emergency Services Physician Group

  • Emergency Medical Services (Emergency Medicine) Physician
  • Chicago, IL
  • NPI 1760587703
  Medicare reassignment
• Farmington Hills Urgent Care Walk-in Clinic PC

  • Urgent Care Clinic/Center
  • Farmington Hills, MI
  • NPI 1144956350
  NPD (past)

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1528531944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772290",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482772290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 W 19TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233501",
            "telephone_number": "313-533-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLADE",
        "first_name": "ELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL PA LICENSE",
            "identifier": "9111866",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL PA LICENSE NUMBER",
            "identifier": "9111866",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Skyline Smiles LLC
• Skyline Smiles of Roscoe Village LLC
• Sla Health LLC
• Courtney Slabaugh
• Charles Slack, MD
• Jamie Slade, M.D.
• Jori Slade, LCSW
• Renee Slade, M.D.
• Bernard Jacob Sladen, PH.D.
• Maggie Sladick

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.