Individual provider Active NPI

Ali J Kilic, MD

  • Family Medicine Physician
  • Kenosha, WI
National Provider Identifier
1053984864
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
81527-20 Issued in WI
Practice address
1020 35TH St
Kenosha, WI 53140-1932
Phone
(262) 652-3500
Fax
(262) 997-0113
NPI assigned
Jul 20, 2021
Last updated
Aug 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 81527-20 WI Primary

Addresses

Primary practice location

1020 35TH St
Kenosha, WI 53140-1932

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

849 Kellogg Ave
Janesville, WI 53546-2808
Phone (608) 755-7960

Other identifiers 1

IdentifierTypeStateIssuer
100238246MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address akilic405050@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230713002438 WI Practitioner - Family Practice 4789044454 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 35TH St
Kenosha, WI 53140-1932
Phone (262) 652-3500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jul 26, 2024 Accepting new patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Jul 26, 2024 Accepting new patients
Mercy Health System Corporation CurrentSince May 2, 2023 Accepting new patients
Mercy Health System Corporation CurrentSince May 2, 2023 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3524 E Milwaukee St
Janesville, WI 53546
Phone (608) 756-7100

849 Kellogg Ave
Janesville, WI 53546
Phone (608) 755-7960

1020 35th St
Kenosha, WI 53140
Phone (262) 652-3500

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Interoperability endpoints

  • Direct secure messaging: akilic405050@direct.myadvocateaurora.org

Organizations & group practices 6

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1053984864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 35TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531401932",
            "telephone_number": "262-652-3500",
            "fax_number": "262-997-0113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "849 Kellogg Ave",
            "address_purpose": "LOCATION",
            "city": "Janesville",
            "state": "WI",
            "postal_code": "535462808",
            "country_code": "US",
            "telephone_number": "608-755-7960",
            "fax_number": "608-755-7873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILIC",
        "first_name": "ALI",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-20",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81527-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100238246",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akilic405050@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 35th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531401932",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1020 35th St",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531401932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.