Individual provider Active NPI

Kathleen E. Anderson,, PA-C

  • Physician Assistant
  • Bannockburn, IL
National Provider Identifier
1487674545
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085001480 Issued in IL
Practice address
2151 Waukegan Rd
Suite 100
Bannockburn, IL 60015-1885
Phone
(847) 444-5300
Fax
(847) 267-0694
NPI assigned
Jul 20, 2006
Last updated
Mar 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

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 085001480 IL Primary
Medical Physician Assistant 363AM0700X 85001480 IL

Addresses

Primary practice location

2151 Waukegan Rd
Suite 100
Bannockburn, IL 60015-1885

Mailing address

2151 Waukegan Rd
Suite 100
Bannockburn, IL 60015-1885
Phone (847) 444-5300

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
I20070712000291 IL Practitioner - Physician Assistant 3173623618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

777 Park Ave W
Highland Park, IL 60035-2433

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85001480ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Cardiologists SC Current Accepting new patients
Endeavor Health Medical Group CurrentSince Jul 13, 2013 Accepting new patients

Locations

2151 Waukegan Rd
Ste 100
Bannockburn, IL 60015
Phone (847) 444-5300

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

6475 Washington St
Ste 1
Gurnee, IL 60031
Phone (847) 432-1580

1117 S Milwaukee Ave
Ste A11
Libertyville, IL 60048

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1487674545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 WAUKEGAN RD",
            "address_2": "SUITE 100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151885",
            "telephone_number": "847-444-5300",
            "fax_number": "847-267-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 WAUKEGAN RD",
            "address_2": "SUITE 100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151885",
            "telephone_number": "847-444-5300",
            "fax_number": "847-267-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON,",
        "first_name": "KATHLEEN",
        "middle_name": "E.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001480",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "85001480",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bannockburn, IL

Sources for this page

Verify at the official NPI Registry.