Individual provider Active NPI

Hayden Elizabeth Bagnell-Pettine, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1801778568
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085011526 Issued in IL
Practice address
1611 W Harrison St Ste 400
Chicago, IL 60612-4861
Phone
(877) 632-6637
NPI assigned
Jul 23, 2025
Last updated
Aug 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X IN
Physician Assistant 363A00000X 085011526 IL Primary

Addresses

Primary practice location

1611 W Harrison St Ste 400
Chicago, IL 60612-4861

Mailing address

PO Box 735263
Chicago, IL 60673-5263

Other names 1

  • Hayden Pettine Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250903001068 IL Practitioner - Physician Assistant 1153822812 Reassigns benefits to 1 organization
I20251021000727 IN Practitioner - Physician Assistant 1153822812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

1611 W Harrison St
Chicago, IL 60612-4861
Phone (877) 632-6637

2011 York Rd
Oak Brook, IL 60523-1992
Phone (877) 632-6637

2450 Wolf Rd
Suite E
Westchester, IL 60154-5643
Phone (877) 632-6637

770 Beloit Rd
Belvidere, IL 61008-1745
Phone (815) 398-9491

9200 Calumet Ave
Suite 300
Munster, IN 46321-2885
Phone (877) 632-6637

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085011526ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthomidwest, PLLC CurrentSince Aug 18, 2025 Accepting new patients
Orthomidwest, PLLC CurrentSince Aug 18, 2025 Accepting new patients
Orthomidwest, PLLC Physician Assistant CurrentSince Oct 7, 2025 Accepting new patients

Locations

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

1611 W Harrison St
Ste 400
Chicago, IL 60612
Phone (312) 243-4244

9200 Calumet Ave
Ste 300
Munster, IN 46321
Phone (708) 236-2737

9601 Calumet Ave
Munster, IN 46321
Phone (312) 432-2591

Interoperability endpoints

  • Direct secure messaging: hayden.bagnell-pettine.1@12576.direct.athenahealth.com

Organizations & group practices 3

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": "1753228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1801778568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735263",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "877-632-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGNELL-PETTINE",
        "first_name": "HAYDEN",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-23",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085011526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HAYDEN",
            "last_name": "PETTINE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.