Active NPI
Alexandra N Lutomski, PA-C
- Physician Assistant
- Skokie, IL
National Provider Identifier
1972022473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.006346
- Practice address
- 9650 Gross Point Rd
Skokie, IL 60076-1214 - Phone
- (847) 677-9600
- NPI assigned
- Sep 15, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 085.006346 | IL | |
| Physician Assistant | 363A00000X | 085.006346 | IL | Primary |
Addresses
Primary practice location
9650 Gross Point Rd
Skokie, IL 60076-1214
Mailing address
9650 Gross Point Rd
Skokie, IL 60076-1214
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 |
|---|---|---|---|
| 085.006346 | IL | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518048000000",
"number": "1972022473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9650 GROSS POINT RD",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600761214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9650 GROSS POINT RD",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600761214",
"telephone_number": "847-677-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTOMSKI",
"first_name": "ALEXANDRA",
"middle_name": "N",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-15",
"last_updated": "2018-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085.006346",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.006346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.