Individual provider Active NPI

Victoria Diane Viveen, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1871131805
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007475 Issued in IL
Practice address
5159 S Ashland Ave
Chicago, IL 60609-4931
Phone
(773) 434-9216
NPI assigned
Dec 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.007475 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
I20200527000869 IL Practitioner - Physician Assistant 5890116057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.007475ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Apr 13, 2020 Accepting new patients
Rush University Medical Group CurrentSince Jun 30, 2024 Accepting new patients
Access Community Health Network CurrentSince Apr 13, 2020 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

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

2835 N Sheffield Ave
Ste 104
Chicago, IL 60657
Phone (312) 876-4577

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1871131805",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVEEN",
        "first_name": "VICTORIA",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-20",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.