Individual provider Active NPI

Mitchel Donovan, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1740038900
Registry record updated Oct 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085011458 Issued in IL
Practice address
676 N Saint Clair St Ste 2100
Chicago, IL 60611-2993
Phone
(312) 695-1800
Fax
(312) 695-4741
NPI assigned
May 10, 2024
Last updated
Oct 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2026

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 085011458 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 2100
Chicago, IL 60611-2993

Mailing address

676 N Saint Clair St Ste 2100
Chicago, IL 60611-2993
Phone (312) 695-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Northwestern University Feinberg Medical School, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5777 Dept
Carol Stream, IL 60122-0021

676 N Saint Clair St
Suite 2100
Chicago, IL 60611-2993

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792540800000",
    "number": "1740038900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112993",
            "telephone_number": "312-695-1800",
            "fax_number": "312-695-4741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112993",
            "telephone_number": "312-695-1800",
            "fax_number": "312-695-4741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "MITCHEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-10",
        "last_updated": "2026-10-21",
        "certification_date": "2026-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085011458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.