Individual provider Active NPI

Emma Raider

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1659903359
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007318 Issued in IL
Practice address
2400 N Ashland Ave
Chicago, IL 60614-2021
Phone
(773) 270-5600
NPI assigned
Feb 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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 085.007318 IL Primary

Addresses

Primary practice location

2400 N Ashland Ave
Chicago, IL 60614-2021

Mailing address

1025 W Webster Ave Unit 3
Chicago, IL 60614-7422
Phone (847) 739-6406

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
I20210615002998 IL Practitioner - Physician Assistant 9133529977 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.007318ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Medspa PLLC PastSince Jun 2, 2024 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: emma.raider.1@13676.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1659903359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 W WEBSTER AVE UNIT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147422",
            "telephone_number": "847-739-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142021",
            "telephone_number": "773-270-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIDER",
        "first_name": "EMMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.