NPIMap

Individual provider Active NPI

Michelle Dawn Ovando, PA-C

  • Medical Physician Assistant
  • Tinley Park, IL
National Provider Identifier
1760676969
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085-02017 Issued in IL
Practice address
18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767
Phone
(708) 444-8300
Fax
(708) 444-8301
NPI assigned
Aug 30, 2007
Last updated
Dec 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085-02017 IL Primary

Addresses

Primary practice location

18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767

Mailing address

18425 W Creek Dr
Ste F
Tinley Park, IL 60477-6767
Phone (708) 444-8300

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL movando293349@direct.myadvocateaurora.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040430000377 IL Practitioner - Physician Assistant 6002803921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Associates LTDGroup PAC ID 8628027273, 11 clinicians

Practice addresses (Care Compare)

13401 S Ridgeland Ave
Palos Heights, IL 60463-1898
Phone (708) 444-8300

18425 W Creek Dr
Suite F
Tinley Park, IL 60477-6768
Phone (708) 444-8300

420 -422 Nelson Rd
New Lenox, IL 60451-2946
Phone (708) 444-8300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.27 of 100Reported as group
Quality
97.09
Improvement activities
40
Cost
81.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-02017ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Associates LTD PastSince Aug 23, 2020 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ACEFAA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1760676969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18425 W CREEK DR",
            "address_2": "STE F",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776767",
            "telephone_number": "708-444-8300",
            "fax_number": "708-444-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18425 W CREEK DR",
            "address_2": "STE F",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776767",
            "telephone_number": "708-444-8300",
            "fax_number": "708-444-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVANDO",
        "first_name": "MICHELLE",
        "middle_name": "DAWN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-02017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "movando293349@direct.myadvocateaurora.org",
            "affiliation": "N",
            "endpointDescription": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "18425 W Creek Dr",
            "address_2": "STE F",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604776767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

Verify at the official NPI Registry.