Dr Mary Kelly

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036077560 Issued in IL

Legal business name

DR MARY KELLY

Practice address

7319 North Ave
River Forest, IL 60305-1220

Phone

(708) 848-0040

NPI assigned

Jun 23, 2008

Last updated

Jun 23, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary KellyNPI 1912087560

Title

Owner

Phone

(708) 848-0040

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Dr Mary Kelly2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mary L. Kelly, D.O., S.C.

  • Medical Specialty Clinic/Center
  • River Forest, IL
  • NPI 1497903314
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Louise Kelly, D.O.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1912087560
  NPD (past) Authorized official

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1164683157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7319 NORTH AVE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051220",
            "telephone_number": "708-848-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7319 NORTH AVE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051220",
            "telephone_number": "708-848-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MARY KELLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-848-0040"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036077560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036077560",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rutheva Dizon-Moore, MD
• Dominican University Wellness Center (Wellness Center)
• Anna Dowd, N.P.
• Molly Jane Downey, RDN
• Dr Heidi Schwartz PSYD & Assoc PC
• Lucelita Abad Duffy, PT
• Elisabeth Dunne, LCPC, LPC, NCC
• Melanie Durolfo-Chavez, APRN
• E. Wagner's Shoes
• Joseph Edwards

• Family Medicine Physician in River Forest, IL
• Providers in River Forest, 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 Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.