NPIMap

Individual provider Active NPI

Brett Wassink, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1902109267
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.004809 Issued in IL
Practice address
259 E Erie St FL 13
Chicago, IL 60611-3926
Phone
(312) 695-6800
Fax
(312) 926-6600
NPI assigned
Dec 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 390200000X
Physician Assistant 363A00000X 085.004809 IL Primary

Addresses

Primary practice location

259 E Erie St FL 13
Chicago, IL 60611-3926

Mailing address

259 E Erie St FL 13
Chicago, IL 60611-3926
Phone (312) 695-6800

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
I20131112001960 IL Practitioner - Physician Assistant 9234365610 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4445 W Irving Park Rd
Chicago, IL 60641-2808

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.004809ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Apr 21, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Apr 21, 2020 Accepting new patients
Illinois Bone and Joint Institute, LLC CurrentSince Jun 15, 2018 Accepting new patients
Illinois Bone and Joint Institute LLC CurrentSince Jun 15, 2018 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

Dept 5777
Carol Stream, IL 60122

259 E Erie St
Fl 13
Chicago, IL 60611

4445 W Irving Park Rd
Ste 310
Chicago, IL 60641

259 E Erie St
Chicago, IL 60611

5057 Paysphere Cir
Chicago, IL 60674

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

716 Florsheim Dr
Libertyville, IL 60048
Phone (847) 918-9077

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1902109267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST FL 13",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113926",
            "telephone_number": "312-695-6800",
            "fax_number": "312-926-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST FL 13",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113926",
            "telephone_number": "312-695-6800",
            "fax_number": "312-926-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSINK",
        "first_name": "BRETT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-08",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.