Individual provider Active NPI

Kaitlin Ann Willham, M.D.

  • Internal Medicine Physician
  • Evanston, IL
National Provider Identifier
1073891990
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125059382 Issued in IL
Practice address
2650 Ridge Ave
Evanston, IL 60201-1718
Phone
(847) 570-2000
NPI assigned
Jul 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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 125059382 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Evanston, IL 60201-1718

Mailing address

2650 Ridge Ave
Evanston, IL 60201-1718
Phone (847) 570-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20151015000552 CA Practitioner - Internal Medicine 9436372703 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
138228CAMDMarriage & Family Therapist
125059382ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UCSF Medical Group Business Services Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
University of California SFGH Medical Group CurrentSince Aug 31, 2015 Accepting new patients
University of California SFGH Medical Group Current Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 1, 2017 Accepting new patients
University of California San Francisco Current Accepting new patients
University of California San Francisco CurrentSince Jul 1, 2017 Accepting new patients
University of California San Francisco Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
University of California SFGH Medical Group Internal Medicine CurrentSince Aug 31, 2015 Accepting new patients
Regents of the University of California Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients

Locations

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

400 Parnassus Ave
San Francisco, CA 94143
Phone (415) 353-2000

1001 Potrero Ave
Rm 5H22
San Francisco, CA 94110
Phone (628) 206-4774

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1073891990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLHAM",
        "first_name": "KAITLIN",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125059382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.