Kelly Ann Pettit, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

117693 Issued in IA

Practice address

659 Ridgeview Dr
McHenry, IL 60050-7012

Phone

(815) 344-1999

NPI assigned

Apr 17, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Neuroclinic and Assessments LLCGroup PAC ID 1658524475, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.16 of 100Reported as group

Quality

80.99

Improvement activities

40

Cost

72.05

Merit-based Incentive Payment System (MIPS)

Final score

91.66 of 100Reported as group

Quality

80.64

Improvement activities

40

Cost

74.35

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Neuroclinic and Assessments, LLC

  • Clinical Psychologist
  • McHenry, IL
  • NPI 1053673988
  Medicare reassignment Care Compare group
• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763

  IA

  Medicare reassignment NPD
• Deer Oaks Mid-West LLC

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1154978476

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685318400000",
    "number": "1194999409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 MCARDLE DR STE C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600141717",
            "telephone_number": "815-338-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "659 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507012",
            "telephone_number": "815-344-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3701 Doty Rd",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "IL",
            "postal_code": "600987509",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10400 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429553",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 W Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600508409",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 E Terra Cotta Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600143621",
            "country_code": "US",
            "telephone_number": "815-344-1999",
            "fax_number": "815-516-5171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042375A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007917",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "117693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "071007917",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael J Petersen, MD
• Kristin Ann Peterson, MA LPC
• Morgan Marie Peterson, QMHP, MSW, LCSW
• Richard Franklin Peterson, C.R.S.S.
• Yuliana Petryshyn, MD
• Taylar A Pfaff
• Jaylee Pfau
• Korinne Pfeifer, MA
• Lauren Pfister
• Mary L Philbin, M.S.

• Clinical Psychologist in McHenry, IL
• Providers in McHenry, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2023; 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.