Mitchell William Kanellis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011732 Issued in IL

Practice address

3450 Lacey Rd
Downers Grove, IL 60515-5430

Phone

(630) 743-4500

Fax

(630) 743-4500

NPI assigned

Nov 30, 2022

Last updated

Mar 1, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Expert Family Eyecare LLCGroup PAC ID 5991182529, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1329.epichosted.com/APIProxyPRD/HOME/api/FHIR/R4
• Direct secure messaging: mkanellis22976@direct.midwestern.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Expert Family Eyecare LLC

  • Eyewear Supplier
  • Lincolnshire, IL
  • NPI 1881335719

  Optometrist

  Medicare reassignment Care Compare group NPD
• Midwestern University

  dba MWU Multispecialty Clinic Downers Grove

  • Clinic/Center
  • Downers Grove, IL
  • NPI 1538445317
  Medicare reassignment NPD
• Midwestern University

  dba Midwestern University Speech Pathology Clinic- Downers Grove

  • Speech-Language Pathologist
  • Downers Grove, IL
  • NPI 1033558952
  NPD
• Midwestern University

  dba Midwestern University Eye Institute-Downers Grove

  • Optometrist
  • Downers Grove, IL
  • NPI 1295126324
  NPD
• Southern College of Optometry

  dba University Eye Care

  • Optometrist
  • Memphis, TN
  • NPI 1518309202
  NPD (past)

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1144930298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 LACEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155430",
            "telephone_number": "630-743-4500",
            "fax_number": "630-743-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LACEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155430",
            "telephone_number": "630-743-4500",
            "fax_number": "630-743-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANELLIS",
        "first_name": "MITCHELL",
        "middle_name": "WILLIAM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-30",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Konstantina Kalas, OD
• Amy Kalten, M.A.; ED. S.
• Aishwarya Kamarajan
• John F Kaminski, D.D.S.
• Alexandria Kampwirth-Garcia, CSFA
• Reuben Kannaby
• Chander Kannan
• Sharon Ann Karel, R.D.H.
• Karen Sheehan, Inc.
• Karen Sheehan, Inc.

• Optometrist in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.