Individual provider Active NPI

Andrea Renee Bevolo, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1932695251
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006765 Issued in IL
Practice address
737 N Michigan Ave Ste 700
Chicago, IL 60611-6662
Phone
(312) 337-6960
Fax
(312) 337-3601
NPI assigned
Jul 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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 085006765 IL Primary

Addresses

Primary practice location

737 N Michigan Ave Ste 700
Chicago, IL 60611-6662

Mailing address

737 N Michigan Ave Ste 700
Chicago, IL 60611-6662
Phone (312) 337-6960

Other practice location 1

10330 S Roberts Rd
Palos Hills, IL 60465-1971
Phone (708) 237-7200

Other practice location 2

19065 Hickory Creek Dr Ste 210
Mokena, IL 60448-8597
Phone (708) 237-7200

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
I20181101001366 IL Practitioner - Physician Assistant 1052664430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

737 N Michigan Ave
Chicago, IL 60611-2615
Phone (847) 582-2104

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 10, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 10, 2021 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

737 N Michigan Ave
Ste 700
Chicago, IL 60611
Phone (312) 337-6960

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 3

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 1

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": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1932695251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 N MICHIGAN AVE STE 700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606116662",
            "telephone_number": "312-337-6960",
            "fax_number": "312-337-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 N MICHIGAN AVE STE 700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606116662",
            "telephone_number": "312-337-6960",
            "fax_number": "312-337-3601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10330 S Roberts Rd",
            "address_purpose": "LOCATION",
            "city": "Palos Hills",
            "state": "IL",
            "postal_code": "604651971",
            "country_code": "US",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19065 Hickory Creek Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488597",
            "country_code": "US",
            "telephone_number": "708-237-7200",
            "fax_number": "708-237-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEVOLO",
        "first_name": "ANDREA",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-10",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.