Carlos Kellenberger, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036-057301 Issued in IL

Practice address

4250 N Marine Dr
Apt 502
Chicago, IL 60613-1744

Phone

(773) 935-0199

NPI assigned

Apr 16, 2007

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 CA, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• County of Fresno

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fresno, CA
  • NPI 1770538001
  Medicare reassignment NPD
• HHC St. Simons Inc

  • Psychiatric Hospital
  • Saint Simons Island, GA
  • NPI 1972557916
  Medicare reassignment NPD
• Uhs of Savannah LLC

  • Psychiatric Hospital
  • Savannah, GA
  • NPI 1427292333
  Medicare reassignment NPD
• County of Fresno

  • State or Local Public Health Clinic/Center
  • Fresno, CA
  • NPI 1174606420
  NPD
• Uhs of Savannah, LLC

  • Psychiatric Hospital
  • Savannah, GA
  • NPI 1003154535
  NPD

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546905600000",
    "number": "1306061122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 N MARINE DR",
            "address_2": "APT 502",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131744",
            "telephone_number": "773-935-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 N MARINE DR",
            "address_2": "APT 502",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131744",
            "telephone_number": "773-935-0199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4441 E Kings Canyon Rd",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937023604",
            "country_code": "US",
            "telephone_number": "559-600-6859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLENBERGER",
        "first_name": "CARLOS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2019-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036-057301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aileen Kelleher, LCSW
• Caroline Kelleher, PA
• Gwyneth M Kelleher, PA
• Megan Kelleher, LCSW
• Michael David Kelleher, MD
• Keller Orthotics Inc
• Keller Orthotics Inc
• Ignacio J Keller Sarmiento, MD
• Austin Michael Keller, MD, MS
• Cheryl Keller, RDH

• Psychiatry Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.