Individual provider Active NPI

Kayla Rose Obernesser, PA-C

  • Physician Assistant
  • Naperville, IL
National Provider Identifier
1124754486
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.009065 Issued in IL
Practice address
120 Spalding Dr Ste 111
Naperville, IL 60540-6766
Phone
(847) 570-2000
NPI assigned
Jul 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.009065 IL Primary

Addresses

Primary practice location

120 Spalding Dr Ste 111
Naperville, IL 60540-6766

Mailing address

2650 Ridge Ave Ste 1223
Evanston, IL 60201-1700

Other names 1

  • Kayla Rose Irwin Former name

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
I20230119000346 IL Practitioner - Physician Assistant 2567833106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

120 Spalding Dr
Suite 205And207
Naperville, IL 60540-6508
Phone (630) 646-6020

24600 W 127TH St
Plainfield, IL 60585-9507

2650 Ridge Ave
Evanston, IL 60201-1700

801 S Washington St
Naperville, IL 60540-7430
Phone (630) 527-5197

Hospital & facility affiliations

  • Edward Hospital Hospital, Naperville, IL, CCN 140231
  • Swedish Hospital Hospital, Chicago, IL, CCN 140114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.009065ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Dec 1, 2024 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

120 Spalding Dr
Ste 111
Naperville, IL 60540
Phone (630) 527-3788

Interoperability endpoints

  • Direct secure messaging: kobernesser284906@direct.edward.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1124754486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE STE 1223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SPALDING DR STE 111",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605406766",
            "telephone_number": "847-570-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBERNESSER",
        "first_name": "KAYLA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.009065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "IRWIN",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.