Michael C Kelly, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

19030568 Issued in IL

Practice address

5425 W Lake St
Chicago, IL 60644-2342

Phone

(773) 378-3347

NPI assigned

May 4, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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.

• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Oak Park, IL
  • NPI 1871516799
  Medicare reassignment NPD
• PCC Community Wellness Center

  dba PCC Austin Dental & Specialty Care Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1134954506
  NPD

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577145600000",
    "number": "1265888655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 S SPRING RD",
            "address_2": "STE A",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601263868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5425 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442342",
            "telephone_number": "773-378-3347"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "568 S Spring Rd",
            "address_2": "Ste A",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601263868",
            "country_code": "US",
            "telephone_number": "630-833-5007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6201 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604021108",
            "country_code": "US",
            "telephone_number": "708-386-0845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-04",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "19030568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen R. Kelly, MSW, LCSW
• Meghan Kelly, MSN, RN, AGACNP-BC
• Meghan Kelly
• Meghan Kelly
• Michael A Kelly, MD
• Natalie Kelly, M.A., CCC-SLP/L
• Paul Kelly
• Rachel Kelly
• Rebekka Kelly, PT
• Richard R Kelly, LCSW

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2019; 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.