Individual provider Active NPI

Kelly Christine Clemens, FNP-BC

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1508427949
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2019034308 Issued in IL
Practice address
1801 W Taylor St
Chicago, IL 60612-4795
Phone
(312) 355-1625
Fax
(312) 355-1515
NPI assigned
Jun 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.422691 IL
Family Nurse Practitioner 363LF0000X 2019034308 IL Primary

Addresses

Primary practice location

1801 W Taylor St
Chicago, IL 60612-4795

Mailing address

1801 W Taylor St
Chicago, IL 60612-4795
Phone (312) 996-9501

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
I20191007002087 IL Practitioner - Nurse Practitioner 8022349091 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Board of Trustees of the University of IllinoisGroup PAC ID 3072422716, 1,134 clinicians

Practice addresses (Care Compare)

1801 W Taylor St
Chicago, IL 60612-4795

845 W Wilson Ave
Uic Medicine
Chicago, IL 60640-8090
Phone (312) 744-1295

Hospital & facility affiliations

  • University of Illinois Hospital and Clinics Hospital, Chicago, IL, CCN 140150

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041.422691ILMDRegistered Nurse
2019034308ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Oct 4, 2019 Accepting new patients
Riverside Health System CurrentSince Oct 4, 2019 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Mar 1, 2020 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Mar 1, 2020 Accepting new patients
Board of Trustees of the University of Illinois Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

835 S Wolcott Ave
Rm W140
Chicago, IL 60612

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

5775 E State Route 113
Coal City, IL 60416
Phone (815) 634-0100

23120 S Lagrange Rd
Ste 200
Frankfort, IL 60423
Phone (815) 464-5440

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Interoperability endpoints

  • Direct secure messaging: kwhite113255@uihealth.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1508427949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-996-9501",
            "fax_number": "312-355-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-355-1625",
            "fax_number": "312-355-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENS",
        "first_name": "KELLY",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.422691",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "2019034308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.