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GIRMA BALCHA ASSEFA M.D.
NPI 1619904992
Internal Medicine in South Holland, IL

Active since June 26, 2006PECOS EnrolledAccepts Medicare Assignment
100 W 162ND ST, SOUTH HOLLAND, IL 60473(708) 730-2200(708) 210-0636 Get Directions Write a Review

NPPES record last updated: December 18, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Girma Balcha Assefa M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GIRMA BALCHA ASSEFA M.D. (NPI 1619904992) is an individual internal medicine provider in South Holland, Illinois, licensed in Illinois (036-078388) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Advocate Trinity Hospital, and is a graduate of Other (1981).

NPPES Registry Identity

NPI1619904992
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameGIRMA BALCHA ASSEFACredential: M.D.
Location Address100 W 162ND STSouth Holland, IL 60473-2003
Mailing Address2311 W 22nd St, Suite 202Oak Brook, IL 60523-1225 · (630) 320-1160
Phone(708) 730-2200
Fax(708) 210-0636
Sole ProprietorNo
Medical School CMSOtherGraduated 1981
Enumeration DateJune 26, 2006
Last NPPES UpdateDecember 18, 2021
NPPES CertifiedDecember 18, 2021
✔ NPI 1619904992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in IL · 036-078388
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
100 W 162ND ST, South Holland, IL 60473
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Girma Balcha Assefa M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799820577
PECOS Enrollment IDI20100304000284
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Girma Assefa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Advocate Health & Hospitals Corporation
10 mi
Medical Specialty
4440 W 95TH ST
Oak Lawn, IL 60453
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: Advocate Health And Hospitals Corporation
  • 4,870 clinicians in this Medicare group
NPI 1912936014 (847) 390-5900

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
275 services158 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
226 services121 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
192 services102 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
77 services77 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
54 services54 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
52 services52 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Advocate Trinity Hospital

Acute Care Hospitals · Chicago, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140048
Location2320 E 93rd StChicago, IL 60617 · Cook County
Emergency services Birthing friendly

Advocate Christ Hospital & Medical Center

Acute Care Hospitals · Oak Lawn, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140208
Location4440 W 95th StreetOak Lawn, IL 60453 · Cook County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60473 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$138.86 typical visit price
range $60.08 – $183.39
Typical copayment $34.71 (range $15.02 – $45.84)
Most-billed visit code 99204
Established Patient
$105.70 typical visit price
range $18.97 – $148.12
Typical copayment $26.42 (range $4.74 – $37.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
16 suppliers45 claims97 services$6.22 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
14 suppliers29 claims42 services$1.07 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEREK A MELBY DO
Internal Medicine
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
JOHNNIE DOMINICA JOHNSON FNP
Nurse Practitioner (Family)
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
SHWETA GANDHI D.O.
Family Medicine
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
ADVOCATE HEALTH AND HOSPITALS CORPORATION
Clinic/Center (Multi-Specialty)
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
JEFFREY W BRANTA D.O.
Family Medicine
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
SUSAN BARCLAY MD
Pediatrics
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
LINA JAMAL ABDALLAH GHAZAL MD
Internal Medicine
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200
DR. CARLOS CONCEPCION M.D.
Internal Medicine
100 W 162ND ST
SOUTH HOLLAND, IL 60473
Cook County (708) 730-2200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Girma Assefa's NPI number?

The NPI number for Girma Assefa is 1619904992. It was assigned to this individual provider in the NPPES registry on June 26, 2006.

Where is Girma Assefa located?

Girma Assefa practices at 100 W 162nd St, South Holland, IL 60473. The listed phone number is (708) 730-2200.

What is Girma Assefa's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Girma Assefa enrolled in Medicare?

Yes. Girma Assefa is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Girma Assefa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Girma Assefa reassigns Medicare benefits to Advocate Health & Hospitals Corporation (Oak Lawn, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Girma Assefa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Girma Assefa accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Girma Assefa as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Girma Assefa affiliated with any hospitals?

According to CMS data, Girma Assefa is affiliated with Advocate Trinity Hospital and Advocate Christ Hospital & Medical Center.

When was this NPI record last updated?

The NPPES record for Girma Assefa was last updated on December 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.