NPIMap

Individual provider Active NPI

Candice Oberlies, PA-C

  • Physician Assistant
  • Oak Park, IL
National Provider Identifier
1598026536
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-001663 Issued in IL
Practice address
1010 Lake St Ste 500
Oak Park, IL 60301-1135
Phone
(708) 524-8600
Fax
(708) 524-8147
NPI assigned
Jun 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

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 085-001663 IL Primary

Addresses

Primary practice location

1010 Lake St Ste 500
Oak Park, IL 60301-1135

Mailing address

1010 Lake St Ste 500
Oak Park, IL 60301-1135
Phone (708) 524-8600

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
I20140521001651 IL Practitioner - Physician Assistant 6103049069 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Street Family Physicians SC IncGroup PAC ID 8123081189, 8 clinicians

Practice addresses (Care Compare)

1010 Lake St
Suite 301
Oak Park, IL 60301-1133
Phone (708) 524-8600

Hospital & facility affiliations

  • Rush Oak Park Hospital Hospital, Oak Park, IL, CCN 140063
  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119
  • West Suburban Medical Center Hospital, Oak Park, IL, CCN 140049
  • Loyola University Medical Center Hospital, Maywood, IL, CCN 140276

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-001663ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group Past Accepting new patients

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402272000000",
    "number": "1598026536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 500",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011135",
            "telephone_number": "708-524-8600",
            "fax_number": "708-524-8147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 500",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011135",
            "telephone_number": "708-524-8600",
            "fax_number": "708-524-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBERLIES",
        "first_name": "CANDICE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-06",
        "last_updated": "2014-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-001663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.