Makenzie Diserio

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.009196 Issued in IL

Practice address

1212 S 2ND St
Dekalb, IL 60115-4435

Phone

(872) 231-3162

Fax

(702) 977-1496

NPI assigned

Jul 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

93.41 of 100Reported as group

Quality

86.81

Improvement activities

40

Cost

77.34

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment
• Integrated Rehab Consultants LLC

  • Physical Medicine & Rehabilitation Physician
  • Chicago, IL
  • NPI 1528379195
  Medicare reassignment
• Cep America - Illinois, LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1720448491
  NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Integrated Rehab Consultants LLC

  • Physical Medicine & Rehabilitation Physician
  • Baltimore, MD
  • NPI 1316829146
  NPD

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1679146302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74008272",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606748272",
            "telephone_number": "702-899-0595",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S 2ND ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154435",
            "telephone_number": "872-231-3162",
            "fax_number": "702-977-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISERIO",
        "first_name": "MAKENZIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-20",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.009196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Diefenderfer
• Tracy A Diehl, LCSW
• Matthew Konrad Dietz, D.M..D.,M.S.
• Binh Q Dinh, DDS
• James A Dionisopoulos, CRNA
• Megan Dixon, LCSW
• Cassie Dodd
• Meryl Greer Domina, LCSW, PH.D.
• Monica Dominguez-Banuelos, MSW
• Sadie Donaghy, PA-C

• Physician Assistant in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.