Individual provider Active NPI

Ayesha Fatima

  • Physician Assistant
  • Addison, IL
National Provider Identifier
1538964465
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085011745 Issued in IL
Practice address
714 N Tamarac Blvd
Addison, IL 60101-1694
Phone
(773) 563-5572
NPI assigned
Feb 14, 2025
Last updated
Dec 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 085011745 IL Primary

Addresses

Primary practice location

714 N Tamarac Blvd
Addison, IL 60101-1694

Mailing address

714 N Tamarac Blvd
Addison, IL 60101-1694
Phone (773) 563-5572

Other practice location 1

779 W Adams St
Chicago, IL 60661-3509
Phone (708) 231-8908

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
I20260128002463 IL Practitioner - Physician Assistant 1658859012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085011745ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc Single Specialty CurrentSince Dec 17, 2025 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Dec 17, 2025 Accepting new patients

Locations

779 W Adams St
Chicago, IL 60661
Phone (312) 382-8308

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

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": "1739491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1538964465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 N TAMARAC BLVD",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601011694",
            "telephone_number": "773-563-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 N TAMARAC BLVD",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601011694",
            "telephone_number": "773-563-5572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "779 W Adams St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606613509",
            "country_code": "US",
            "telephone_number": "708-231-8908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FATIMA",
        "first_name": "AYESHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085011745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, IL

Sources for this page

Verify at the official NPI Registry.