Individual provider Active NPI

Kathryn Ilissa Ross, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1124434014
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
259 E Erie St Ste 1600
Chicago, IL 60611-3111
Phone
(312) 695-5620
Fax
(312) 695-2310
NPI assigned
Jul 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN004758 PA
Medical Physician Assistant 363AM0700X 085006742 IL
Physician Assistant 363A00000X IL Primary

Addresses

Primary practice location

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

Mailing address

259 E Erie St Ste 1600
Chicago, IL 60611-3111
Phone (312) 695-5620

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190711001074 IL Practitioner - Physician Assistant 5799010864 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rockford Psychiatric Medical Services SCGroup PAC ID 6901089515, 154 clinicians

Practice addresses (Care Compare)

1512 Artaius Pkwy
Suite 102
Libertyville, IL 60048-5231
Phone (847) 847-2230

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
DN004758PAMDRegistered Dietitian
085006742ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center CurrentSince Jan 27, 2025 Accepting new patients
Rockford Psychiatric Medical Services, S.C. CurrentSince Jan 27, 2026 Accepting new patients
Rush University Medical Group CurrentSince Jan 27, 2025 Accepting new patients
Central Dupage Physician Group PastSince Nov 1, 2019 Accepting new patients
Miinehealth, Inc. PastSince Jan 25, 2023 Accepting new patients

Locations

1725 W Harrison St
Ste 818
Chicago, IL 60612
Phone (312) 942-4444

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

32 E 1st St
Hinsdale, IL 60521

1512 Artaius Pkwy
Ste 102
Libertyville, IL 60048
Phone (847) 847-2230

5851 W 95th St
Oak Lawn, IL 60453
Phone (708) 574-6143

1639 N Alpine Rd
Ste 260
Rockford, IL 61107
Phone (815) 395-1500

Organizations & group practices 6

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": "1405036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1124434014",
    "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": "312-695-5620",
            "fax_number": "312-695-2310"
        },
        {
            "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": "312-695-5620",
            "fax_number": "312-695-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KATHRYN",
        "middle_name": "ILISSA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN004758",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085006742",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.