Active NPI
Mikaela Lynne McGrory, PA-C
- Physician Assistant
- Forest Park, IL
National Provider Identifier
1851666226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085004288
- Practice address
- 8200 W. Roosevelt Road
Forest Park, IL 60130-2528 - Phone
- (708) 488-9850
- Fax
- (708) 488-9870
- NPI assigned
- Mar 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085004288 | IL | Primary |
Addresses
Primary practice location
8200 W. Roosevelt Road
Forest Park, IL 60130-2528
Mailing address
401 N Michigan Ave
Suite 1200
Chicago, IL 60611-4264
Phone (312) 635-0973
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085004288 | Other | IL | LICENSE NO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085004288 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446076800000",
"number": "1851666226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 N MICHIGAN AVE",
"address_2": "SUITE 1200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114264",
"telephone_number": "312-635-0973",
"fax_number": "813-290-9691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 W. ROOSEVELT ROAD",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601302528",
"telephone_number": "708-488-9850",
"fax_number": "708-488-9870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGRORY",
"first_name": "MIKAELA",
"middle_name": "LYNNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-18",
"last_updated": "2015-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085004288",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NO",
"identifier": "085004288",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.