Kelley Thuy-Ly Phan

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010616 Issued in IL

Practice address

259 E Erie St Ste 1600
Chicago, IL 60611-3111

Phone

(312) 695-6868

Fax

(312) 695-2729

NPI assigned

Dec 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

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

State licenses

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.

• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1114433463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113111",
            "telephone_number": "312-695-6868",
            "fax_number": "312-695-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113111",
            "telephone_number": "312-695-6868",
            "fax_number": "312-695-2729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Moon Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Hoffman Estates",
            "state": "IL",
            "postal_code": "601691010",
            "country_code": "US",
            "telephone_number": "714-404-0383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KELLEY",
        "middle_name": "THUY-LY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-22",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "071010616",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelley.phan@amitahealth.org",
            "affiliation": "N",
            "endpointDescription": "work-affiliated, email address, encryption enabled",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1650 Moon Lake Blvd",
            "city": "Hoffman Estates",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601691010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diana T Phan, M.D.
• Duy Quoc Phan
• Hoangmai Thi Phan, M.D
• Jennifer Phan
• Jun Phan, RDN,LDN
• Khang D Phan
• Victor Phan, DO
• Natalie Phanco
• Marissa Pharel
• Pharmacia El Amanecer, Inc (Pharmacia El Amanecer)

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.