Individual provider Active NPI

Elizabeth A Walsh, P.A.-C

  • Medical Physician Assistant
  • Chicago, IL
National Provider Identifier
1538403548
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085006176 Issued in IL
Practice address
1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone
(312) 563-1358
NPI assigned
Nov 15, 2012
Last updated
Oct 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106939 FL
Medical Physician Assistant 363AM0700X 017211-1 NY
Medical Physician Assistant 363AM0700X 085006176 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
Chicago, IL 60612-3833

Mailing address

123 N Desplaines St Apt 1010
Chicago, IL 60661-2305
Phone (561) 308-1639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017211-1NYMDDental Hygienist

Interoperability endpoints

  • Direct secure messaging: ewalsh139670@direct.rush.rush-health.com

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1538403548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 N DESPLAINES ST APT 1010",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612305",
            "telephone_number": "561-308-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-563-1358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106939",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017211-1",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085006176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.