Individual provider Active NPI

Kylee J Ladd, PA

  • Physician Assistant
  • Naperville, IL
National Provider Identifier
1336104934
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-005152 Issued in IL
Practice address
1160 E Ogden Ave Ste 106
Naperville, IL 60563-2693
Phone
(331) 226-0315
Fax
(331) 226-0315
NPI assigned
Apr 18, 2006
Last updated
Aug 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085-005152 IL Primary
Medical Physician Assistant 363AM0700X 055-0030279 VT

Addresses

Primary practice location

1160 E Ogden Ave Ste 106
Naperville, IL 60563-2693

Mailing address

3832 Grassmere Rd
Naperville, IL 60564-8234
Phone (802) 782-7500

Other practice location 1

260 Crest Rd
Suite 101
Saint Albans, VT 05478-9503
Phone (802) 524-1223

Other identifiers 1

IdentifierTypeStateIssuer
9000230MedicaidVT

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150804004936 IL Practitioner - Physician Assistant 6002850047 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-005152ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fastrac Medical, P.C. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kylee.ladd.1@14940.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1336104934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3832 GRASSMERE RD",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648234",
            "telephone_number": "802-782-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E OGDEN AVE STE 106",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632693",
            "telephone_number": "331-226-0315",
            "fax_number": "331-226-0315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "260 Crest Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Saint Albans",
            "state": "VT",
            "postal_code": "054789503",
            "country_code": "US",
            "telephone_number": "802-524-1223",
            "fax_number": "802-524-1095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LADD",
        "first_name": "KYLEE",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-005152",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "055-0030279",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000230",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.