Active NPI
Annie Zambrano, PA-C
- Physician Assistant
- Melrose Park, IL
National Provider Identifier
1962716514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.003806
- Practice address
- 1111 Superior St
Suite 104
Melrose Park, IL 60160-4138 - Phone
- (708) 486-2700
- Fax
- (708) 486-2702
- NPI assigned
- Aug 5, 2010
- Last updated
- Jun 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 085.003806 | IL | Primary |
Addresses
Primary practice location
1111 Superior St
Suite 104
Melrose Park, IL 60160-4138
Mailing address
1111 Superior St
Suite 104
Melrose Park, IL 60160-4138
Phone (708) 486-2700
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1400 E Irving Park Rd
Streamwood, IL 60107-3201
Phone (630) 837-9000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.003806 | IL | MD | Physician Assistant |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Streamwood, IL
- NPI 1619916822
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- Oak Park, IL
- NPI 1467496224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1962716514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 SUPERIOR ST",
"address_2": "SUITE 104",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601604138",
"telephone_number": "708-486-2700",
"fax_number": "708-486-2702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 SUPERIOR ST",
"address_2": "SUITE 104",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601604138",
"telephone_number": "708-486-2700",
"fax_number": "708-486-2702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAMBRANO",
"first_name": "ANNIE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-05",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.003806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.