Active NPI
Erin M. Kelly, R.D., L.D.N.
- Registered Dietitian
- North Chicago, IL
National Provider Identifier
1508030073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 3001 Green Bay Road
North Chicago, IL 60064 - Phone
- (847) 636-3786
- NPI assigned
- Apr 16, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
3001 Green Bay Road
North Chicago, IL 60064
Mailing address
33 N. Ridgemoor Ave
Mundelein, IL 60060
Phone (847) 636-3786
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L91589 | Other | IL | MEDICARE PART B |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308182400000",
"number": "1508030073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 N. RIDGEMOOR AVE",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "60060",
"telephone_number": "847-636-3786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GREEN BAY ROAD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "60064",
"telephone_number": "847-636-3786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ERIN",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "R.D., L.D.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-16",
"last_updated": "2011-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "L91589",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.