Kelly Marie Caruso, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-002871 Issued in IL

Practice address

20060 Governors Dr Ste 300
Olympia Fields, IL 60461-1099

Phone

(708) 283-2600

Fax

(708) 833-7248

NPI assigned

Nov 21, 2006

Last updated

Dec 23, 2021By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JEDEBA/Endpoint/JEDEBA
• Direct secure messaging: kcaruso293338@direct.myadvocateaurora.org

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.

• San Pablo Medical Center, LTD.

  dba North Avenue Physicians Center, Division Physicians Center

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1548323330
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1336214782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20060 GOVERNORS DR STE 300",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611099",
            "telephone_number": "708-283-2600",
            "fax_number": "708-833-7248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20060 GOVERNORS DR STE 300",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611099",
            "telephone_number": "708-283-2600",
            "fax_number": "708-833-7248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARUSO",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcaruso293338@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "20060 Governors Dr Ste 300",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "20060 Governors Dr Ste 300",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Care Partners LLC
• Alicia Carpenter, DPT
• Julie Ann Carr
• Orius Carter
• Bridgette Millicent Cartwright Arnett, M.D., PHD
• Jason Carvajal
• Cathy Jackson Sharper Clarity, P.C.
• Cep America Illinois Intensivists
• Cepamerica Illinois LLP
• Richard Ceragioli, M.D.

• Physician Assistant in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.