Alyssa Brie Ketchum, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085005549 Issued in IL

Practice address

676 N Saint Clair St Ste 1900
Chicago, IL 60611-2986

Phone

(312) 926-5354

NPI assigned

Jul 14, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alyssa Brie Teasdale Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

Merit-based Incentive Payment System (MIPS)

Final score

95.19 of 100Reported as apm

Quality

83.05

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Rush University Medical Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542
  Medicare reassignment NPD
• Rush University Medical Center

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1184269425
  NPD

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

• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1104200625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1900",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112986",
            "telephone_number": "312-926-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1900",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112986",
            "telephone_number": "312-926-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHUM",
        "first_name": "ALYSSA",
        "middle_name": "BRIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085005549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "TEASDALE",
            "middle_name": "BRIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ralph M Kester, D.C.
• Jennifer M. Kestner, PHD
• Stevin Christopher Kestner, DPM
• Abdulhamid S Keswani, M.D.
• Bhavika Surendra Keswani
• Naphaphone Kathy Kethdy, APRN, CNP
• Andrew R Ketterer, M.D.
• Lois Kettering, DPT
• Petra Ketterl, MD
• Mark Ketterson, LCSW

• Surgical Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.