Carly Kelleher, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2051 Plainfield Rd
Crest Hill, IL 60403-1865

Phone

(815) 741-4343

Fax

(815) 741-8660

NPI assigned

Feb 7, 2022

Last updated

Jul 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Medical Center Hospital, Joliet, IL, CCN 140007

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.kelleher@forefrontdermatology.emadirect.md

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.

• Forefront Dermatology, S.C.

  dba Premier Dermatology

  • Dermatology Physician
  • Crest Hill, IL
  • NPI 1053783308
  Medicare reassignment Care Compare group
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Wheaton, IL
  • NPI 1194462382
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Colorado Springs, CO
  • NPI 1881305084
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph Medical Center - Joliet LLC

  • General Acute Care Hospital
  • Joliet, IL
  • NPI 1760220198
  Care Compare affiliation

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1376297564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 PLAINFIELD RD",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031865",
            "telephone_number": "815-741-4343",
            "fax_number": "815-741-8660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1520 Bond St",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605632358",
            "country_code": "US",
            "telephone_number": "630-357-7536",
            "fax_number": "630-904-0413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "CARLY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-07",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Carly.Kelleher@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "2051 Plainfield Rd",
            "city": "Crest Hill",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604031865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Carly.Kelleher@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "1520 Bond St",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605632358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jlspencer LTD
• Jeremiah Jobe, MSW,LSW
• Erika Jones
• Rolla Naim Kattoum, DMD
• Stephanie Kazantsev, M.D.
• Matthew R Kelleher, MD
• Samia Khan, D.D.S.
• Gaith Khatlan, DMD
• Hilwa Khattab
• Richard Kiang, M.D.

• Physician Assistant in Crest Hill, IL
• Providers in Crest Hill, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.