Individual provider Active NPI

Clifford Whitehouse, PA-C

  • Physician Assistant
  • Park Ridge, IL
National Provider Identifier
1780647362
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-004982 Issued in IL
Practice address
250 S Northwest Hwy Ste 100
Park Ridge, IL 60068-4237
Phone
(773) 631-7898
Fax
(773) 631-3005
NPI assigned
Apr 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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 085-004982 IL Primary

Addresses

Primary practice location

250 S Northwest Hwy Ste 100
Park Ridge, IL 60068-4237

Mailing address

900 Rand Rd Ste 300
Des Plaines, IL 60016-2359
Phone (847) 324-3976

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
I20140218000461 IL Practitioner - Physician Assistant 6507095502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1775 Dempster St
Park Ridge, IL 60068-1143
Phone (847) 723-5099

2101 Waukegan Rd
Bannockburn, IL 60015-1836

250 S Northwest Hwy
Park Ridge, IL 60068-4237

4440 W 95TH St
Oak Lawn, IL 60453-2600
Phone (708) 684-8000

7435 W Talcott Ave
Chicago, IL 60631-3707
Phone (773) 774-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.07 of 100Reported as group
Quality
76.54
Promoting interoperability
83
Improvement activities
40
Cost
74.52

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-004982ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Bone and Joint Institute LLC CurrentSince Aug 1, 2020 Accepting new patients
Illinois Bone and Joint Institute, LLC CurrentSince Aug 1, 2020 Accepting new patients

Locations

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

7447 W Talcott Ave
Ste 500
Chicago, IL 60631
Phone (312) 631-7898

5057 Paysphere Cir
Chicago, IL 60674

900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090

250 S Northwest Hwy
Ste 100
Park Ridge, IL 60068
Phone (773) 631-7898

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 2

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": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1780647362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RAND RD STE 300",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162359",
            "telephone_number": "847-324-3976",
            "fax_number": "847-929-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S NORTHWEST HWY STE 100",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684237",
            "telephone_number": "773-631-7898",
            "fax_number": "773-631-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHOUSE",
        "first_name": "CLIFFORD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-004982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.