NPIMap

Individual provider Active NPI

Kelly Vuong, MD

  • Internal Medicine Physician
  • Glen Ellyn, IL
National Provider Identifier
1073511135
Registry record updated Oct 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036110420 Issued in IL
Practice address
885 Roosevelt Rd Ste 201
Glen Ellyn, IL 60137-6141
Phone
(630) 545-3760
Fax
(630) 545-3769
NPI assigned
Jul 12, 2005
Last updated
Oct 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036110420 IL Primary

Addresses

Primary practice location

885 Roosevelt Rd Ste 201
Glen Ellyn, IL 60137-6141

Mailing address

885 Roosevelt Rd Ste 201
Glen Ellyn, IL 60137-6141
Phone (630) 545-3760

Other identifiers 5

IdentifierTypeStateIssuer
036110420MedicaidIL
206147OtherILMEDICARE PTAN (GROUP)
206147101OtherILMEDICARE PTAN (INDIVIDUAL)
CA4748OtherILRAILROAD MEDICARE PTAN (GROUP)
P01053223OtherILRAILROAD MEDICARE PTAN (INDIVIDUAL)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040313000063 IL Practitioner - Internal Medicine 6608765003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

285 Roosevelt Rd
Glen Ellyn, IL 60137-5618
Phone (630) 469-0045

875 Roosevelt Rd
Suite B
Glen Ellyn, IL 60137-6101
Phone (630) 315-1830

885 Roosevelt Rd
Glen Ellyn, IL 60137-6141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group Internal Medicine CurrentSince Mar 1, 2012 Accepting new patients
Central Dupage Physician Group CurrentSince Mar 1, 2012 Accepting new patients
Broadway Medical Group Past Accepting new patients
Swedish Covenant Management Services, Inc Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

885 Roosevelt Rd
Ste 201
Glen Ellyn, IL 60137
Phone (630) 384-6330

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

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 7

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": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1073511135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 ROOSEVELT RD STE 201",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376141",
            "telephone_number": "630-545-3760",
            "fax_number": "630-545-3769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 ROOSEVELT RD STE 201",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376141",
            "telephone_number": "630-545-3760",
            "fax_number": "630-545-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VUONG",
        "first_name": "KELLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036110420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110420",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "206147101",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN (GROUP)",
            "identifier": "CA4748",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "P01053223",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

Verify at the official NPI Registry.