NPIMap

Individual provider Active NPI

Miteshkumar N Modi, PA-C

  • Physician Assistant
  • Marion, IL
National Provider Identifier
1891829222
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2401 W Main St
Marion, IL 62959-1188
Phone
(618) 997-5311
NPI assigned
Mar 15, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

2401 W Main St
Marion, IL 62959-1188

Mailing address

9835 Garden CT
Schiller Park, IL 60176-2101
Phone (847) 671-0521

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100319000187 IL Practitioner - Physician Assistant 4385779032 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physicians Home Care LLCGroup PAC ID 9436522968, 5 clinicians
Access Community Health NetworkGroup PAC ID 9537076112, 182 clinicians

Practice addresses (Care Compare)

1508 Bloomingdale Rd
Suite B
Glendale Heights, IL 60139-2758
Phone (331) 871-6674

7450 W 63Rd St
Des Plaines Valley Family Health Center
Summit, IL 60501-1816
Phone (708) 458-0757

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.002919ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake County Acute Care, LLP CurrentSince Dec 29, 2010 Accepting new patients
Access Community Health Network CurrentSince Oct 12, 2020 Accepting new patients
Lake County Acute Care, LLP CurrentSince Dec 29, 2010 Accepting new patients
Access Community Health Network CurrentSince Oct 12, 2020 Accepting new patients
Cook County CurrentSince Aug 1, 2011 Accepting new patients
Cook County CurrentSince Aug 1, 2011 Accepting new patients
Cottage Emergency Physicians LLC Past Accepting new patients

Locations

150 W Half Day Rd
Buffalo Grove, IL 60089
Phone (847) 215-0000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

25706 Network Pl
Chicago, IL 60673

2701 W 68th St
Chicago, IL 60629
Phone (773) 471-8000

4909 W Division St
Chicago, IL 60651
Phone (773) 854-8000

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

Interoperability endpoints

  • Direct secure messaging: mmodi19135@direct.achn.net

Organizations & group practices 12

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891829222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9835 GARDEN CT",
            "city": "SCHILLER PARK",
            "state": "IL",
            "postal_code": "601762101",
            "telephone_number": "847-671-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W MAIN ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591188",
            "telephone_number": "618-997-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "MITESHKUMAR",
        "middle_name": "N",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.