Individual provider Active NPI

Shannon Keith, ARNP

  • Family Nurse Practitioner
  • Aurora, IL
National Provider Identifier
1558198739
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209030612 Issued in IL
Practice address
3965 75TH St Ste 103
Aurora, IL 60504-7926
Phone
(630) 375-1625
Fax
(630) 429-9870
NPI assigned
Sep 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209030612 IL Primary

Addresses

Primary practice location

3965 75TH St Ste 103
Aurora, IL 60504-7926

Mailing address

3965 75TH St Ste 103
Aurora, IL 60504-7926
Phone (630) 375-1625

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
I20250624002886 IL Practitioner - Nurse Practitioner 5294274650 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Post Acute Medical PLLCGroup PAC ID 5193156115, 433 clinicians
Vitae Health Medical Illinois, PLLCGroup PAC ID 2365798410, 214 clinicians
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

101 E Via Ghiglieri
Toluca, IL 61369-9596
Phone (877) 883-9430

222 N Hammes Ave
Joliet, IL 60435-8161
Phone (815) 725-0443

800 Division St
Dixon, IL 61021-4107
Phone (248) 660-1220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209030612ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Post Acute Medical PLLC CurrentSince May 20, 2025 Accepting new patients
Lawrence T. Kacmar M.D., S.C. Sports Medicine CurrentSince Sep 23, 2024 Accepting new patients
Complexcare Medical Group Midwest H PLLC CurrentSince Feb 2, 2026 Accepting new patients
Theoria Medical CurrentSince Jun 12, 2025 Accepting new patients
Lawrence T. Kacmar MDSC PastSince Sep 23, 2024 Accepting new patients

Locations

400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297

3965 75th St
Ste 103
Aurora, IL 60504
Phone (630) 375-1625

490 W 16th Pl
Chicago Hts, IL 60411
Phone (708) 481-4444

471 W Terra Cotta Ave
Crystal Lake, IL 60014
Phone (815) 455-0550

3354 Jerome Ln
East Saint Louis, IL 62206
Phone (618) 337-9400

1101 E State St
Geneva, IL 60134
Phone (630) 208-1876

555 W Carpenter St
Springfield, IL 62702
Phone (217) 525-1880

101 E Via Ghiglieri
Toluca, IL 61369
Phone (815) 452-2367

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

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.

NPI Registry JSON

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1558198739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 75TH ST STE 103",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047926",
            "telephone_number": "630-375-1625",
            "fax_number": "630-429-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 75TH ST STE 103",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047926",
            "telephone_number": "630-375-1625",
            "fax_number": "630-429-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH",
        "first_name": "SHANNON",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-19",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209030612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.