Individual provider Active NPI

William Sideras, PA-C

  • Physician Assistant
  • Calumet Park, IL
National Provider Identifier
1700429040
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007284 Issued in IL
Practice address
12850 S Ashland Ave
Calumet Park, IL 60827-6308
Phone
(630) 581-5372
NPI assigned
Oct 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 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 085.007284 IL Primary

Addresses

Primary practice location

12850 S Ashland Ave
Calumet Park, IL 60827-6308

Mailing address

12850 S Ashland Ave
Calumet Park, IL 60827-6308

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
I20191031002689 IL Practitioner - Physician Assistant 9436481058 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

12200 Western Ave
Blue Island, IL 60406-1398
Phone (708) 631-2781

17119 La Grange Rd
Tinley Park, IL 60487-7203
Phone (708) 942-6707

3258 W 111TH St
Chicago, IL 60655-2729
Phone (773) 629-8217

3314 S Cicero Ave
Cicero, IL 60804-4531
Phone (708) 656-3831

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

4323 S Pulaski Rd
Chicago, IL 60632-4008
Phone (773) 389-3591

5521 S Kedzie Ave
Unit 106
Chicago, IL 60629-2448
Phone (773) 306-2546

6239 S Archer Ave
Chicago, IL 60638-2609
Phone (708) 929-1569

6320 S Cass Ave
Westmont, IL 60559-3207
Phone (331) 481-6869

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.007284ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Orthopaedics at Rush LLC CurrentSince Nov 1, 2019 Accepting new patients
Midwest Anesthesia and Pain Specialists SC CurrentSince Jun 9, 2020 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Oct 11, 2022 Accepting new patients
Midwest Anesthesia and Pain Specialists, SC CurrentSince Jun 9, 2020 Accepting new patients
Midwest Express Care 2, Inc CurrentSince Oct 11, 2022 Accepting new patients
Midwest Orthopaedics at Rush, LLC CurrentSince Nov 1, 2019 Accepting new patients

Locations

12850 S Ashland Ave
Calumet Park, IL 60827
Phone (708) 631-2781

1611 W Harrison St
Ste 400
Chicago, IL 60612
Phone (312) 243-4244

1644 E 53rd St
Chicago, IL 60615
Phone (773) 241-6450

1611 W Harrison St
#400
Chicago, IL 60612
Phone (312) 243-4244

9680 Golf Rd
Des Plaines, IL 60016
Phone (773) 362-2917

1 Westbrook Corporate Ctr
Ste 240
Westchester, IL 60154

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 6

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": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1700429040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12850 S ASHLAND AVE",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12850 S ASHLAND AVE",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276308",
            "telephone_number": "630-581-5372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDERAS",
        "first_name": "WILLIAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-18",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet Park, IL

Sources for this page

Verify at the official NPI Registry.