Individual provider Active NPI

Stephen Mizera, PA-C

  • Physician Assistant
  • Bolingbrook, IL
National Provider Identifier
1770147092
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006977 Issued in IL
Practice address
396 Remington Blvd Ste 130
Bolingbrook, IL 60440-4309
Phone
(630) 759-1248
NPI assigned
Apr 23, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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 085006977 IL Primary

Addresses

Primary practice location

396 Remington Blvd Ste 130
Bolingbrook, IL 60440-4309

Mailing address

396 Remington Blvd Ste 130
Bolingbrook, IL 60440-4309
Phone (630) 759-1248

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stephen.mizera.1@380.direct.athenahealth.com

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
I20190711003414 IL Practitioner - Physician Assistant 2961737002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians

Practice addresses (Care Compare)

396 Remington Blvd
Bolingbrook, IL 60440-4311

396 Remington Blvd
Suite 380
Bolingbrook, IL 60440-4302
Phone (224) 273-4000

500 Remington Blvd
Bolingbrook, IL 60440-4906
Phone (630) 856-3075

6084 S Archer Ave
Chicago, IL 60638-2747
Phone (773) 229-8508

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners,Inc CurrentSince Jun 17, 2019 Accepting new patients
Adventist Health Partners, Inc. CurrentSince Jun 17, 2019 Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

396 Remington Blvd
Ste 130
Bolingbrook, IL 60440
Phone (630) 312-5000

Interoperability endpoints

  • Direct secure messaging: smizera1240681@adventhealth.direct-ci.com
  • Direct secure messaging: stephen.mizera.1@380.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.

Hospital & facility affiliations 5

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": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1770147092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 REMINGTON BLVD STE 130",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404309",
            "telephone_number": "630-759-1248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 REMINGTON BLVD STE 130",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404309",
            "telephone_number": "630-759-1248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZERA",
        "first_name": "STEPHEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-23",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephen.mizera.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "396 Remington Blvd Ste 130",
            "city": "Bolingbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604404309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.