| Richard A Disanto, PA-C | |
|
5201 Willow Springs Rd, La Grange, IL 60525-6537 | |
| (708) 579-0018 | |
| (708) 579-7571 |
| Full Name | Richard A Disanto |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 26 Years |
| Location | 5201 Willow Springs Rd, La Grange, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235290883 | NPI | - | NPPES |
| 1046964 | Other | NCCPA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 1046964 (Illinois) | Secondary |
| 363AM0700X | Physician Assistant - Medical | 085001519 (Illinois) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Rush University Medical Group | 5496658874 | 1521 |
| Entity Name | Edward Health Ventures |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962452912 PECOS PAC ID: 4284531484 Enrollment ID: O20031216000616 |
| Entity Name | Rush University Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093819542 PECOS PAC ID: 5496658874 Enrollment ID: O20040202000228 |
| Entity Name | Edward Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013969013 PECOS PAC ID: 0042108110 Enrollment ID: O20040309001279 |
| Entity Name | Illinois Emergency Medicine Specialists LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003150962 PECOS PAC ID: 6103071808 Enrollment ID: O20130304000132 |
| Mailing Address | Practice Location Address |
|---|---|
| Richard A Disanto, PA-C 5201 Willow Springs Rd, La Grange, IL 60525 Ph: (708) 579-0018 | Richard A Disanto, PA-C 5201 Willow Springs Rd, La Grange, IL 60525-6537 Ph: (708) 579-0018 |
Karen Fu, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 31 E Ogden Ave Unit 118, La Grange, IL 60525 Phone: 720-470-6427 |
Tracy Bongiorno, P.A.-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 4727 Willow Springs Rd, Unit 3s, La Grange, IL 60525 Phone: 708-482-1099 Fax: 708-482-0335 |
Ms. Samantha Marie Boburka, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 110 W Calendar Ave, La Grange, IL 60525 Phone: 708-745-5277 Fax: 708-579-2408 |
Ms. Kelsey York, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1415 W 47th St, La Grange, IL 60525 Phone: 708-579-9375 Fax: 708-579-9378 |