Colin Burroughs, PA-C
Individual provider Active NPI Physician Assistant · Lake Bluff, IL
NPI 1821179367 · NPPES record last updated Mar 29, 2023
Key facts
- NPI
- 1821179367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1052848 (NE)
- Practice address
- 925 Sherwood Dr
Lake Bluff, IL 60044-2203 - Phone
- (847) 234-1177
- Fax
- (847) 234-1875
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Skin Dermatology, LLC
Northshore Dermatology Center SC
Practice addresses (Care Compare)
1950 45TH St
Suite 200
Munster, IN 46321-3958
Phone (219) 912-3376
3612 Lake Ave
Suite 2B
Wilmette, IL 60091-1000
Phone (847) 853-7900
925 Sherwood Dr
Lake Bluff, IL 60044-2203
Phone (847) 234-1177
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230404000384 | IL | Practitioner - Physician Assistant | 4587764683 | Reassigns benefits to 1 organization |
| I20260121003275 | IN | Practitioner - Physician Assistant | 4587764683 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1052848 | NE | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skin Dermatology, LLC | Current |
Accepting new patients |
Locations
1950 45th St
Ste 200
Munster, IN 46321
Phone (219) 912-3376
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1052848 | NE | Yes |
Addresses
Primary practice location
925 Sherwood Dr
Lake Bluff, IL 60044-2203
Mailing address
925 Sherwood Dr
Lake Bluff, IL 60044-2203
Phone (847) 234-1177
Other practice location 1
1850 W Winchester Rd Ste 106
Libertyville, IL 60048-5355
Phone (847) 234-1177
Other practice location 2
3612 Lake Ave Ste 2B
Wilmette, IL 60091-1000
Phone (847) 256-9400
Other providers in Lake Bluff, IL
- David Peter Bronsveld
- Rachell Buhler
- Anita Bukszar
- Kathleen Marie Burke
- Timothy Burks
- Karen Burton
- Jennifer Calliss
- Amanda Marie Campbell
- Luther Campbell
- Amy Carnow
All providers in Lake Bluff, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.