Individual provider Active NPI

Maryam Michelle Beintema, PA-C

  • Physician Assistant
  • Evanston, IL
National Provider Identifier
1912525932
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085008470 Issued in IL
Practice address
633 Emerson St
Evanston, IL 60208-0844
Phone
(847) 491-8100
Fax
(847) 491-5919
NPI assigned
Jul 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

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 085008470 IL Primary

Addresses

Primary practice location

633 Emerson St
Evanston, IL 60208-0844

Mailing address

633 Emerson St
Evanston, IL 60208-0844
Phone (847) 491-8100

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
I20250729004137 IL Practitioner - Physician Assistant 3476935941 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085008470ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 21, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 21, 2025 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Tapestry 360 Health Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

633 Emerson St
Evanston, IL 60208
Phone (847) 491-2151

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1912525932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 EMERSON ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080844",
            "telephone_number": "847-491-8100",
            "fax_number": "847-491-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 EMERSON ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080844",
            "telephone_number": "847-491-8100",
            "fax_number": "847-491-5919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEINTEMA",
        "first_name": "MARYAM",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-07",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085008470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.