Active NPI
Keycare Medical, P.a.
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1134835978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- KEYCARE MEDICAL, P.A.
- Practice address
- 1713 W. Diversey Pkwy
Suite G
Chicago, IL 60614 - Phone
- (331) 472-7443
- NPI assigned
- Jan 25, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karil Ann Walther
- Title
- Vice President Practice Operations
- Phone
- (608) 235-7970
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Pediatrics Physician | 208000000X |
Addresses
Primary practice location
1713 W. Diversey Pkwy
Suite G
Chicago, IL 60614
Mailing address
1440 W Taylor St # 227
Chicago, IL 60607-4623
Phone (331) 472-7443
Other names 1
- KeyCare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider DirectoryInteroperability endpoints
- https://epicproxy.et1284.epichosted.com/FHIRProxy/api/FHIR/R4/
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674604800000",
"number": "1134835978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 W TAYLOR ST # 227",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606074623",
"telephone_number": "331-472-7443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1713 W. DIVERSEY PKWY",
"address_2": "SUITE G",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60614",
"telephone_number": "331-472-7443"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KEYCARE MEDICAL, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2023-01-12",
"status": "A",
"authorized_official_last_name": "WALTHER",
"authorized_official_first_name": "KARIL",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "VICE PRESIDENT PRACTICE OPERATIONS",
"authorized_official_telephone_number": "608-235-7970"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "KeyCare",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.