Active NPI
Matthew C Kelly, PHARMD
- Pharmacist
- Chicago, IL
National Provider Identifier
1376826610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051289977
- Practice address
- 4005 W 26TH St
Chicago, IL 60623-3709 - Phone
- (773) 521-9504
- NPI assigned
- Sep 22, 2011
- Last updated
- Sep 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051289977 | IL | Primary |
Addresses
Primary practice location
4005 W 26TH St
Chicago, IL 60623-3709
Mailing address
5832 Ridge Ave
Berkeley, IL 60163-1542
Phone (312) 593-7016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051289977 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
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": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1376826610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5832 RIDGE AVE",
"city": "BERKELEY",
"state": "IL",
"postal_code": "601631542",
"telephone_number": "312-593-7016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 W 26TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606233709",
"telephone_number": "773-521-9504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MATTHEW",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-22",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051289977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.