Individual provider Active NPI

Riley Mae Bormann, PA-C

  • Physician Assistant
  • Skokie, IL
National Provider Identifier
1891450565
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009920 Issued in IL
Practice address
9977 Woods Dr # 100
Skokie, IL 60077-1057
Phone
(243) 642-2732
NPI assigned
Nov 7, 2021
Last updated
Aug 23, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 085009920 IL Primary

Addresses

Primary practice location

9977 Woods Dr # 100
Skokie, IL 60077-1057

Mailing address

9977 Woods Dr # 100
Skokie, IL 60077-1057
Phone (243) 642-2732

Other practice location 1

1101 Beacon St Ste 8-West
Brookline, MA 02446-5587
Phone (617) 855-7288

Other names 1

  • Riley Mae Flake Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220615000194 CO Practitioner - Physician Assistant 7517346901 Reassigns benefits to 1 organization
I20230928001021 IL Practitioner - Physician Assistant 7517346901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Sep 13, 2023 Accepting new patients
Valley View Hospital Association CurrentSince May 1, 2022 Accepting new patients
Valley View Hospital Association CurrentSince May 1, 2022 Accepting new patients

Locations

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

9977 Woods Dr
#100
Skokie, IL 60077
Phone (243) 642-2732

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1636243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1891450565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR # 100",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "243-642-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9977 WOODS DR # 100",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771057",
            "telephone_number": "243-642-2732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Beacon St Ste 8-West",
            "address_purpose": "LOCATION",
            "city": "Brookline",
            "state": "MA",
            "postal_code": "024465587",
            "country_code": "US",
            "telephone_number": "617-855-7288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORMANN",
        "first_name": "RILEY",
        "middle_name": "MAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-07",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RILEY",
            "last_name": "FLAKE",
            "middle_name": "MAE",
            "credential": "RILEY MAE FLAKE, PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.