Active NPI
Courtney R Carlson, PA-C
- Physician Assistant
- Chicago, IL
National Provider Identifier
1942516224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.003873
- Practice address
- 676 N. St. Clair
Suite 1835
Chicago, IL 60611-3129 - Phone
- (312) 926-3535
- Fax
- (312) 926-3585
- NPI assigned
- Aug 25, 2010
- Last updated
- Feb 25, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.003873 | IL | Primary |
Addresses
Primary practice location
676 N. St. Clair
Suite 1835
Chicago, IL 60611-3129
Mailing address
676 N. St. Clair
Suite 1835
Chicago, IL 60611-3129
Phone (312) 926-3535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.003873 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Suburban Urology Associates SC | Past | Accepting new patients | |
| Uropartners, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393286400000",
"number": "1942516224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "676 N. ST. CLAIR",
"address_2": "SUITE 1835",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113129",
"telephone_number": "312-926-3535",
"fax_number": "312-926-3585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "676 N. ST. CLAIR",
"address_2": "SUITE 1835",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113129",
"telephone_number": "312-926-3535",
"fax_number": "312-926-3585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "COURTNEY",
"middle_name": "R",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-25",
"last_updated": "2014-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.003873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.