Elena Vladimirovna Medyanik, PHYSICIANS ASSISTAN

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007121 Issued in IL

Practice address

22285 N Pepper Rd Ste 201
Lake Barrington, IL 60010-2540

Phone

(847) 382-5080

Fax

(847) 382-0923

NPI assigned

Sep 17, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1811547375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22285 N PEPPER RD STE 201",
            "city": "LAKE BARRINGTON",
            "state": "IL",
            "postal_code": "600102540",
            "telephone_number": "847-382-5080",
            "fax_number": "847-382-0923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22285 N PEPPER RD STE 201",
            "city": "LAKE BARRINGTON",
            "state": "IL",
            "postal_code": "600102540",
            "telephone_number": "847-382-5080",
            "fax_number": "847-382-0923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Station Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147978",
            "country_code": "US",
            "telephone_number": "847-382-5080",
            "fax_number": "847-382-0923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 N Randall Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Elgin",
            "state": "IL",
            "postal_code": "601237805",
            "country_code": "US",
            "telephone_number": "847-382-5080",
            "fax_number": "847-382-0923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDYANIK",
        "first_name": "ELENA",
        "middle_name": "VLADIMIROVNA",
        "credential": "PHYSICIANS ASSISTAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Erin Lozar, M.S. CCC SLP/L
• Rachel Maigler
• Nicholas Joseph Malooley, D.C.
• Noelle Mark
• Bailee L McDonald, DO
• Thomas J Meyer, M.D.
• Erin E Micklinghoff, CNP
• Midwest Advanced Radiology Center, LLC
• Nicole Lynn Miller, OT
• Ann L Minciotti, MD

• Physician Assistant in Lake Barrington, IL
• Providers in Lake Barrington, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.