Individual provider Active NPI

Mahnoor Moin, PA

  • Physician Assistant
  • Orland Park, IL
National Provider Identifier
1639686009
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010543 Issued in IL
Practice address
15300 West Ave Ste 210
Orland Park, IL 60462-4686
Phone
(708) 226-2870
Fax
(708) 226-2390
NPI assigned
Jan 5, 2018
Last updated
Oct 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110006027 VA
Physician Assistant 363A00000X 085010543 IL Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

15300 West Ave Ste 210
Orland Park, IL 60462-4686

Mailing address

15300 West Ave Ste 210
Orland Park, IL 60462-4686
Phone (708) 226-2870

Other identifiers 1

IdentifierTypeStateIssuer
1639686009MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA, IL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20180222000633 DC Practitioner - Physician Assistant 1759642341 Reassigns benefits to 2 organizations
I20180326000988 VA Practitioner - Physician Assistant 1759642341 Reassigns benefits to 2 organizations
I20240905001696 IL Practitioner - Physician Assistant 1759642341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

12251 S 80TH Ave
Palos Heights, IL 60463-1290

3300 Gallows Rd
Falls Church, VA 22042-3307

3600 Joseph Siewick Dr
Fairfax, VA 22033-1709
Phone (703) 391-3600

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.52 of 100Reported as group
Quality
56.13
Promoting interoperability
98
Improvement activities
40
Cost
80.61

Merit-based Incentive Payment System (MIPS)

Final score
83.36 of 100Reported as group
Quality
73.03
Promoting interoperability
100
Improvement activities
40
Cost
71.49

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Aug 22, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Aug 22, 2024 Accepting new patients
Inova Health Care Services CurrentSince Jun 23, 2024 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Old Dominion Anesthesia LLC Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

15300 West Ave
Ste 210
Orland Park, IL 60462
Phone (708) 226-2870

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 7

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 5

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": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1639686009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 210",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624686",
            "telephone_number": "708-226-2870",
            "fax_number": "708-226-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 210",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624686",
            "telephone_number": "708-226-2870",
            "fax_number": "708-226-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOIN",
        "first_name": "MAHNOOR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006027",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010543",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639686009",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

Verify at the official NPI Registry.