Individual provider Active NPI

Kyle T Cummisford, PA-C

  • Medical Physician Assistant
  • Lake Forest, IL
National Provider Identifier
1548754153
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085006665 Issued in IL
Practice address
1000 N Westmoreland Rd
Lake Forest, IL 60045-1658
Phone
(847) 234-5600
NPI assigned
Jun 18, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2022

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
Medical Physician Assistant 363AM0700X 085006665 IL Primary

Addresses

Primary practice location

1000 N Westmoreland Rd
Lake Forest, IL 60045-1658

Mailing address

1000 N Westmoreland Rd
Lake Forest, IL 60045-1658

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
I20180918001931 IL Practitioner - Physician Assistant 3375894181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

1000 N Westmoreland Rd
Pavillion B 3Rd FL
Lake Forest, IL 60045-1659
Phone (847) 535-8500

1000 Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

600 N Westmoreland Rd
Suite 1100
Lake Forest, IL 60045-1659
Phone (847) 535-9510

660 N Westmoreland Rd
Lake Forest, IL 60045-1659
Phone (847) 234-5600

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

Hospital & facility affiliations

  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Sep 24, 2018 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 24, 2018 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

1000 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6150

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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 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": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1548754153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451658",
            "telephone_number": "847-234-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUMMISFORD",
        "first_name": "KYLE",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085006665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.