Individual provider Active NPI

William Thomas Kvasnicka, P.A.-C

  • Medical Physician Assistant
  • Chicago, IL
National Provider Identifier
1801225024
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085.004850 Issued in IL
Practice address
5159 S Ashland Ave
Chicago, IL 60609-4931
Phone
(773) 434-9216
Fax
(773) 434-2670
NPI assigned
Nov 7, 2013
Last updated
Nov 7, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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 085.004850 IL Primary

Addresses

Primary practice location

5159 S Ashland Ave
Chicago, IL 60609-4931

Mailing address

5159 S Ashland Ave
Chicago, IL 60609-4931
Phone (773) 434-9216

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
I20131204001075 IL Practitioner - Physician Assistant 2062648629 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085.004850ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Howard Brown Health Center CurrentSince Jan 1, 2017 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2014 Accepting new patients
Howard Brown Health Center CurrentSince Jan 1, 2017 Accepting new patients
Access Community Health Network CurrentSince Nov 11, 2013 Accepting new patients
Access Community Health Network CurrentSince Nov 11, 2013 Accepting new patients
Howard Brown Health Center Past Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

5159 S Ashland Ave
Chicago, IL 60609
Phone (773) 424-9216

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Interoperability endpoints

  • Direct secure messaging: wkvasnicka580980@direct.ochin.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1801225024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5159 S ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606094931",
            "telephone_number": "773-434-9216",
            "fax_number": "773-434-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5159 S ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606094931",
            "telephone_number": "773-434-9216",
            "fax_number": "773-434-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KVASNICKA",
        "first_name": "WILLIAM",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-07",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.004850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.