Courtney Ann Kelly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085003055 Issued in IL

Practice address

1345 Edwards St Ste 2
Morris, IL 60450-1692

Phone

(815) 942-1421

Fax

(815) 488-2033

NPI assigned

Sep 24, 2007

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

Other identifiers 1

Other names 1

• Ms. Courtney Ann Verdeyen Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Morris Hospital

  • General Practice Physician
  • Morris, IL
  • NPI 1558466268

  IL

  Medicare reassignment NPD
• Morris Hospital

  • Health Service Clinic/Center
  • Morris, IL
  • NPI 1376658658
  NPD
• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  NPD (past)
• Global Care S.C.

  • Interventional Cardiology Physician
  • Barrington, IL
  • NPI 1033309042
  NPD (past)

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1265628275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-941-9124",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 EDWARDS ST STE 2",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501692",
            "telephone_number": "815-942-1421",
            "fax_number": "815-488-2033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Surryse Rd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Lake Zurich",
            "state": "IL",
            "postal_code": "600473217",
            "country_code": "US",
            "telephone_number": "847-438-2144",
            "fax_number": "847-719-0335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "COURTNEY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "085.003055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "VERDEYEN",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marleen S Kamel
• Ryan H Kays, OD
• Thomas M Kazmierczak Jr., DO
• Keith W Jaeschke DDS PC
• Keith W. Jaeschke D.D.S., P.C.
• Kathleen Kelly, LCSW
• Meghan Kelly
• Kellie Kennedy
• Aftab A Khan, M.D.
• Barbara G Kijek, MD

• All providers in Morris, IL
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.