Active NPI
James Martin Kedrow, PA-C
- Physician Assistant
- North Chicago, IL
National Provider Identifier
1083674295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 921-023
- Practice address
- 3001 Green Bay Rd
North Chicago, IL 60064-3048 - Phone
- (847) 688-6755
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 921-023 | WI | Primary |
Addresses
Primary practice location
3001 Green Bay Rd
North Chicago, IL 60064-3048
Mailing address
1806 Midday Dr
Zion, IL 60099-9252
Phone (847) 688-6755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 921-023 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518048000000",
"number": "1083674295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1806 MIDDAY DR",
"city": "ZION",
"state": "IL",
"postal_code": "600999252",
"telephone_number": "847-688-6755",
"fax_number": "847-688-2722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643048",
"telephone_number": "847-688-6755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEDROW",
"first_name": "JAMES",
"middle_name": "MARTIN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2018-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "921-023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.