Scott Ahlstrom

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

534 Green Bay Rd
Kenilworth, IL 60043-1801

Phone

(847) 256-5505

NPI assigned

Mar 15, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: scott.ahlstrom.1@20375.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 and National Provider Directory roles.

• Kenilworth Medical Associates, S.C.

  • Allergy & Immunology Physician
  • Kenilworth, IL
  • NPI 1366579054
  Medicare reassignment

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1538628938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 IROQUOIS RD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431801",
            "telephone_number": "847-256-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHLSTROM",
        "first_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Accelerated Rehabilitation Centers, LTD (Athletico Physical Therapy)
• Motunrayo Adisa, M.D
• Afg Guidance Center Kenilworth, Inc.
• Laurie B. Anderson-Kramer, LCSW
• Art Carpenter DDS LTD
• Tiffiny Brinkley, MPT
• Beth Britton, M.A.
• Conrad James Burghardt

• Medical Physician Assistant in Kenilworth, IL
• Providers in Kenilworth, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.