Douglas S Stevens, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

IL085-001302 Issued in IL

Practice address

12701 W 143Rd St
Suite 200
Homer Glen, IL 60491-7715

Phone

(877) 694-7722

Fax

(815) 531-0055

NPI assigned

Jan 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Associated Urological Specialists

  • Urology Physician
  • Morris, IL
  • NPI 1407998834
  NPD (past)
• Uropartners, LLC

  • Non-Pharmacy Dispensing Site
  • Chicago Ridge, IL
  • NPI 1467471540
  NPD (past)

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1881673085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 200",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "877-694-7722",
            "fax_number": "815-531-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 W 143RD ST",
            "address_2": "SUITE 200",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604917715",
            "telephone_number": "877-694-7722",
            "fax_number": "815-531-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "DOUGLAS",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001302",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "IL085-001302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "085001302",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rana Srour, DMD
• Step by Step Behavior Therapy
• Agnieszka Stryjek
• Suburban Wellness SC
• Natalie Swartz
• Derek Szeliga, PHARMD
• Muhammad Taha, PHARMD

• All providers in Homer Glen, IL
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.