Kelley Wilson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070027807 Issued in IL

Practice address

1611 W Harrison St Ste 107
Chicago, IL 60612-4861

Phone

(877) 632-6637

Fax

(708) 409-5179

NPI assigned

Jan 23, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, IL2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelley.wilson.1@12576.direct.athenahealth.com

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.

• Orthomidwest, PLLC

  • Orthopaedic Surgery Physician
  • Rockford, IL
  • NPI 1730136474

  IN, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Orthomidwest, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Buffalo Grove, IL
  • NPI 1043180839
  NPD

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1114789401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "877-632-6637",
            "fax_number": "708-409-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "877-632-6637",
            "fax_number": "708-409-5179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 Calumet Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212885",
            "country_code": "US",
            "telephone_number": "877-632-6637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05015428A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070027807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordann Wilson, MD
• Joseph Wilson
• Joshua Alexander Wilson
• Joslyn Christina Wilson, RBT
• Julie R Wilson, DC
• Kenneth Wilson
• Kevin Wilson, DDS
• Kevin M Wilson
• Lauren N Wilson
• Lisa Charivukalayil Wilson

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.