Individual provider Active NPI

Paulina Joanna Henry

  • Physician Assistant
  • Joliet, IL
National Provider Identifier
1639649494
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006985 Issued in IL
Practice address
2202 Essington Rd Ste 101
Joliet, IL 60435-1604
Phone
(815) 676-5310
NPI assigned
Dec 4, 2018
Last updated
Dec 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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 085006985 IL Primary

Addresses

Primary practice location

2202 Essington Rd Ste 101
Joliet, IL 60435-1604

Mailing address

20 W Logan St
Lemont, IL 60439-3863

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
I20190426000229 IL Practitioner - Physician Assistant 1254673031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Renuka H Bhatt MDSCGroup PAC ID 1557378478, 7 clinicians

Practice addresses (Care Compare)

2202 Essington Rd
Suite 101
Joliet, IL 60435-1604
Phone (815) 676-5310

2202 Essington Rd
Suite 101
Joliet, IL 60435-1634

Merit-based Incentive Payment System (MIPS)

Final score
96.77 of 100Reported as group
Quality
93.53
Improvement activities
40

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: pbosek@fineskin.encitedirect.com

Organizations & group practices 1

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": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1639649494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W LOGAN ST",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604393863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 ESSINGTON RD STE 101",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604351604",
            "telephone_number": "815-676-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "PAULINA",
        "middle_name": "JOANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-04",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.