Jeannette Suzanne Codere Kelly, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

125063705 Issued in IL

Practice address

180 N Michigan Ave Ste 1605
Chicago, IL 60601-7478

Phone

(312) 994-3000

Fax

(612) 201-1202

NPI assigned

Jun 13, 2013

Last updated

Sep 12, 2019By the provider in NPPES

Sex

Female

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Michigan Avenue Primary Care SCGroup PAC ID 4385898865, 3 clinicians

Resilience Healthcare - Lakefront Medical Associates LLCGroup PAC ID 5991046468, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jeannette.kelly.1@18552.direct.athenahealth.com
• Direct secure messaging: jkelly284216@direct.myadvocateaurora.org

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.

• Michigan Avenue Primary Care, S.C.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1013239672
  Medicare reassignment Care Compare group NPD
• Resilience Healthcare - Lakefront Medical Associates, LLC

  dba Chicago Health Medical Group

  • General Practice Physician
  • Chicago, IL
  • NPI 1205301926
  Medicare reassignment Care Compare group NPD
• Michigan Avenue Immediate Care

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1174658694
  Medicare reassignment NPD
• Michigan Avenue ENT P.C.

  • Otolaryngology Physician
  • Chicago, IL
  • NPI 1043735483
  NPD

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1154769081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1605",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017478",
            "telephone_number": "312-994-3000",
            "fax_number": "612-201-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1605",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017478",
            "telephone_number": "312-994-3000",
            "fax_number": "612-201-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JEANNETTE",
        "middle_name": "SUZANNE CODERE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-13",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125063705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dympna M Kelly, MD
• Elizabeth Kelly, NP
• Elizabeth Kelly, MS, RN, IBCLC
• Ella Kelly, RN
• Erin Lynn Kelly, LSW
• Jennifer Kelly
• Jennifer Kelly, MSN, APRN, FNP-BC
• Jennifer Ann Kelly, LCSW
• Joanna Katarzyna Kelly, M.D.
• John J Kelly, DDS

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; 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.