Individual provider Active NPI

Mikaila Levigne, PA

  • Physician Assistant
  • Lisle, IL
National Provider Identifier
1548962806
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-010718 Issued in IL
Practice address
430 Warrenville Rd Ste 300
Lisle, IL 60532-1348
Phone
(630) 364-7850
Fax
(630) 432-6604
NPI assigned
Mar 20, 2023
Last updated
Dec 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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 085-010718 IL Primary

Addresses

Primary practice location

430 Warrenville Rd Ste 300
Lisle, IL 60532-1348

Mailing address

Pob 7132960
Chicago, IL 60677-0001
Phone (630) 469-9200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mlevigne267250@dulyhealthandcare.direct-ci.com Direct

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
I20241126000173 IL Practitioner - Physician Assistant 4880129014 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

1325 N Meacham Rd
Schaumburg, IL 60173-4824
Phone (888) 385-9669

1800 N Main St
Wheaton, IL 60187-3149
Phone (630) 665-6200

2100 Glenwood Ave
Joliet, IL 60435-5487
Phone (815) 725-2121

220 Springfield Dr
Suite 300
Bloomingdale, IL 60108-2215
Phone (630) 469-9200

40 S Clay St
Hinsdale, IL 60521-3257

430 Pennsylvania Ave
Glen Ellyn, IL 60137-4464
Phone (630) 469-9200

430 Warrenville Rd
Suite 210
Lisle, IL 60532-1348
Phone (630) 432-6180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-010718ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD CurrentSince Dec 16, 2024 Accepting new patients
Dupage Medical Group LTD CurrentSince Dec 16, 2024 Accepting new patients

Locations

430 Warrenville Rd
Ste 300
Lisle, IL 60532
Phone (630) 364-7850

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1548962806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB 7132960",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770001",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WARRENVILLE RD STE 300",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321348",
            "telephone_number": "630-364-7850",
            "fax_number": "630-432-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVIGNE",
        "first_name": "MIKAILA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-010718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlevigne267250@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "430 Warrenville Rd Ste 300",
            "city": "Lisle",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605321348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

Verify at the official NPI Registry.