MARYBETH BOLANOWSKI (PA) – Physician Assistant, NPI 1891781639
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
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Provider Addresses for MARYBETH BOLANOWSKI (PA)
1860 PAYSPHERE CIR
CHICAGO, IL 606743698
Phone: (630) 469-9200
Type: Mailing
4115, Fairview Avenue, Downers Grove, DuPage County, Illinois, 60515, United States
DOWNERS GROVE, IL 605152268
Phone: (630) 968-1881
Fax: (630) 968-3762
Type: Location
1801 S HIGHLAND AVE STE 220
LOMBARD, IL 601484932
Phone: (630) 790-1872
Type: Location
PO BOX 713260
CHICAGO, IL 606771260
Phone: (630) 469-9200
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $235.
Total Amount is formed as General ($235) + Research ($0) + Ownership ($0) = $235.
Last reported payment date: 2024-10-11 • Largest payer in this snapshot: Zimmer Biomet Holdings, Inc. ($210).
Total Amount
$235
General + Research + Ownership
Payments
4
Total payment records
General Amount
$235
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Zimmer Biomet Holdings, Inc. | $210 |
| Medical Device Business Services, Inc. | $25 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2008-08-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20080814000339 | I | Physician Assistant | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 120 | 94 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 100 | 24 | $0 |
| 27447 | Replacement of knee joint, both sides of knee | 61 | 58 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 36 | 30 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 19 | 19 | $0 |
Insurance plans in this area (ZIP 60674)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | IL | 20610 | Aspiration and/or injection of large joint or joint capsule | 25 | 18 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| E N D O C R I N O L O G Y | IL | |
| Radiation Oncology | IL | |
| Internal Medicine | IL | |
| G A S T R O E N T E R O L O G Y | IL | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IL | |
| Family Practice | IL | |
| P S Y C H I A T R Y | IL | |
| Physician Assistant | IL | |
| Family Practice | IL |
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