Dominique V Azarcon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-003546 Issued in IL

Practice address

1420 Renaissance Dr
Suite 207
Park Ridge, IL 60068-1330

Phone

(847) 296-6161

Fax

(847) 296-6262

NPI assigned

Sep 21, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vivek Gupta, M.D., S.C.Group PAC ID 3678668308, 28 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence Saints Mary and Elizabeth Medical Center Hospital, Chicago, IL, CCN 140180

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Vivek Gupta, M.D., S.C.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1033300694

  IL

  Medicare reassignment Care Compare group
• Advent Neurology SC

  • Neurology Physician
  • Arlington Heights, IL
  • NPI 1205913308

  IL

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Mary of Nazareth Hospital - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1265270607

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1780918920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 RENAISSANCE DR",
            "address_2": "SUITE 207",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681330",
            "telephone_number": "847-296-6161",
            "fax_number": "847-296-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 RENAISSANCE DR",
            "address_2": "SUITE 207",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681330",
            "telephone_number": "847-296-6161",
            "fax_number": "847-296-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Biesterfield Rd Ste 610",
            "address_purpose": "LOCATION",
            "city": "Elk Grove Village",
            "state": "IL",
            "postal_code": "600073362",
            "country_code": "US",
            "telephone_number": "847-981-3630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZARCON",
        "first_name": "DOMINIQUE",
        "middle_name": "V",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-21",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dominique.azarcon.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "800 Biesterfield Rd Ste 610",
            "city": "Elk Grove Village",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600073362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Christopher Atienza, M.D.
• Haider Attarwala, DO
• Ekta Kaur Aulakh-Patel, LCPC
• Avantara Park Ridge LLC
• Avenues to Independence
• Roza Kostadinova Azmanova, L.AC.
• B2B Global USA, Inc
• Raja M. Bahu, M.D.
• Kellyn Bailey, OTR/L
• Mackenzie Ann Bailey, BS

• All providers in Park Ridge, IL
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.