Kelly Marie Demers, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.008933 Issued in IL

Practice address

1786 Moon Lake Blvd
Suite 104
Hoffman Estates, IL 60169-5029

Phone

(847) 755-8090

Fax

(847) 843-7393

NPI assigned

Sep 4, 2007

Last updated

Feb 23, 2016By 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 2

Addresses

Other names 1

• Kelly Marie Shaughnessy Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alexian Brothers Behavioral Health HospitalGroup PAC ID 9537062138, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kelly.demers.1@15182.direct.athenahealth.com

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.

• Alexian Brothers Behavioral Health Hospital

  dba Alexian Brothers Behavioral Health Hospital Outpatient Group Practice

  • Psychiatry Physician
  • Hoffman Estates, IL
  • NPI 1801318928
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1386838225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1786 MOON LAKE BLVD",
            "address_2": "SUITE 104",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695029",
            "telephone_number": "847-755-8090",
            "fax_number": "847-843-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1786 MOON LAKE BLVD",
            "address_2": "SUITE 104",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601695029",
            "telephone_number": "847-755-8090",
            "fax_number": "847-843-7393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMERS",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-04",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.008933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SHAUGHNESSY",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aleksandr Dekhtyar, MD
• Gabriela Anna Del Real
• Jeffrey G Delaney
• Jill Delarco, CADC
• Megan Deligio, LCPC
• Vanessa Jayne Demito, LPC
• Mark P Demus, MD
• Sara E Denton, PT, DPT
• Dependable Home Medical Equipment, LLC
• Dana Derouin

• Clinical Psychologist in Hoffman Estates, IL
• Providers in Hoffman Estates, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.