Active NPI
Cassadana Kirk, PA
- Physician Assistant
- Melrose Park, IL
National Provider Identifier
1205308756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006868
- Practice address
- 1225 W Lake St
Melrose Park, IL 60160-4039 - Phone
- (708) 681-3000
- NPI assigned
- Dec 21, 2018
- Last updated
- Dec 21, 2018
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006868 | IL | Primary |
Addresses
Primary practice location
1225 W Lake St
Melrose Park, IL 60160-4039
Mailing address
716 S Stough St
Hinsdale, IL 60521-4351
Phone (219) 508-5727
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006868 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545350400000",
"number": "1205308756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 S STOUGH ST",
"city": "HINSDALE",
"state": "IL",
"postal_code": "605214351",
"telephone_number": "219-508-5727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 W LAKE ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601604039",
"telephone_number": "708-681-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "CASSADANA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-21",
"last_updated": "2018-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "006868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.