Organization Active NPI

Keycare Medical, P.a.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1134835978
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
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

Updated by the provider on Jan 25, 2023

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)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251201000039 FL Part B Supplier - Clinic/Group Practice 5799278602 Receives reassigned benefits from 1 practitioner
Practice locations: Weston, FL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: 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.

Verify at the official NPI Registry.