Individual provider Active NPI

Kendall R Mosby-Thompson

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1154107845
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209028233 Issued in IL
Practice address
1500 S Fairfield Ave
Chicago, IL 60608-1782
Phone
(773) 257-4750
NPI assigned
Sep 7, 2023
Last updated
Sep 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209028233 IL Primary
Registered Nurse 163W00000X 041403454 IL

Addresses

Primary practice location

1500 S Fairfield Ave
Chicago, IL 60608-1782

Mailing address

1713 W Wallen Ave
Chicago, IL 60626-5585
Phone (773) 653-9184

Other practice location 1

2701 W 68th St
Chicago, IL 60629-1882
Phone (773) 884-9000

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
I20231023000384 IL Practitioner - Nurse Practitioner 3577919935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

California Ave at 15TH St
Chicago, IL 60608-1858
Phone (773) 542-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.03 of 100Reported as group
Quality
71.53
Promoting interoperability
100
Improvement activities
40
Cost
76.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041403454ILMDRegistered Nurse
209028233ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Community Foundation Current Accepting new patients
Mount Sinai Community Foundation CurrentSince Aug 22, 2023 Accepting new patients
Sinai Community Foundation CurrentSince Aug 22, 2023 Accepting new patients

Locations

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

2701 W 68th St
Chicago, IL 60629
Phone (773) 471-8000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1154107845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 W WALLEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606265585",
            "telephone_number": "773-653-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S FAIRFIELD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081782",
            "telephone_number": "773-257-4750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 W 68th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606291882",
            "country_code": "US",
            "telephone_number": "773-884-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSBY-THOMPSON",
        "first_name": "KENDALL",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209028233",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041403454",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.