Active NPI
Kelley Kathleen Staley, M.D.
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1184652984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036115572
- Practice address
- 1701 W Superior St
Chicago, IL 60622-5646 - Phone
- (312) 666-3494
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036115572 | IL | Primary |
Addresses
Primary practice location
1701 W Superior St
Chicago, IL 60622-5646
Mailing address
1126 Wisconsin Ave
Oak Park, IL 60304-1820
Phone (312) 217-1662
Other practice location 1
5841 S Maryland Ave
Chicago, IL 60637-1447
Phone (773) 702-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036115572 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1184652984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1126 WISCONSIN AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041820",
"telephone_number": "312-217-1662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 W SUPERIOR ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606225646",
"telephone_number": "312-666-3494"
}
],
"practiceLocations": [
{
"address_1": "5841 S Maryland Ave",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606371447",
"country_code": "US",
"telephone_number": "773-702-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STALEY",
"first_name": "KELLEY",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036115572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.