NPIMap

Individual provider Active NPI

Bonnie J Vastola-Lewan, D.O.

  • Family Medicine Physician
  • Batavia, IL
National Provider Identifier
1558529909
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-123825 Issued in IL
Practice address
2500 W Fabyan Pkwy
Batavia, IL 60510-1572
Phone
(630) 879-2110
NPI assigned
May 31, 2008
Last updated
Nov 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125049895 IL
Family Medicine Physician 207Q00000X 036-123825 IL Primary

Addresses

Primary practice location

2500 W Fabyan Pkwy
Batavia, IL 60510-1572

Mailing address

2357 Sequoia Dr
Aurora, IL 60506-6222
Phone (630) 859-6800

Other identifiers 2

IdentifierTypeStateIssuer
036123825MedicaidIL
04515143OtherILBCBS #

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bvastolalewan206504@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090821000189 IL Practitioner - Family Practice 1850445065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2500 W Fabyan Pkwy
Batavia, IL 60510-1572
Phone (630) 879-2110

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036-123825ILMDFamily Medicine Physician
125049895ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Oct 1, 2022 Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients

Locations

1221 N Highland Ave
Aurora, IL 60506
Phone (630) 859-6700

2357 Sequoia Dr
Aurora, IL 60506
Phone (630) 859-6700

2500 W Fabyan Pkwy
Batavia, IL 60510
Phone (630) 879-2110

28594 Network Pl
Chicago, IL 60673

Organizations & group practices 3

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 9

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": "1212192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1558529909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 SEQUOIA DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605066222",
            "telephone_number": "630-859-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W FABYAN PKWY",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605101572",
            "telephone_number": "630-879-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASTOLA-LEWAN",
        "first_name": "BONNIE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-31",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125049895",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-123825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036123825",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS #",
            "identifier": "04515143",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bvastolalewan206504@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2500 W Fabyan Pkwy",
            "city": "Batavia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605101572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2500 W Fabyan Pkwy",
            "city": "Batavia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605101572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Batavia, IL

Sources for this page

Verify at the official NPI Registry.