Kelsey H Smith, P

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085008913 Issued in IL

Practice address

880 W Central Rd Dept of
Arlington Heights, IL 60005-2355

Phone

(847) 570-1440

Fax

(847) 570-1442

NPI assigned

Aug 8, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

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

Merit-based Incentive Payment System (MIPS)

Final score

84.9 of 100Reported as group

Quality

75.91

Promoting interoperability

99

Improvement activities

40

Cost

74.6

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksmith180581@direct.myadvocateaurora.org
• Direct secure messaging: ksmith149468@direct.nch.org

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.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Endeavor Health Clinical Operations

  • Psychiatric Hospital Unit
  • Highland Park, IL
  • NPI 1770527236
  NPD (past)

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1568916583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 W CENTRAL RD",
            "address_2": "DEPARTMENT OF NEUROSURGERY",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052355",
            "telephone_number": "847-570-1440",
            "fax_number": "847-570-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 W CENTRAL RD DEPT OF",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052355",
            "telephone_number": "847-570-1440",
            "fax_number": "847-570-1442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 W Oklahoma Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532154330",
            "country_code": "US",
            "telephone_number": "414-649-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 W Kinnickinnic River Pkwy Ste 260",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153631",
            "country_code": "US",
            "telephone_number": "414-649-6780",
            "fax_number": "414-649-6030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 W Kinnickinnic River Pkwy Ste 630",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "53215",
            "country_code": "US",
            "telephone_number": "414-385-1922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELSEY",
        "middle_name": "H",
        "credential": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3881",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "3881-23",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085008913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100060159",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksmith180581@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy Ste 630",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy Ste 630",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Caitlyn Smith
• Courtney Smith, DMD
• Eddie R Smith, PT
• Jacklynn Smith, RBT
• Julia Smith
• Manda Shae Smith, NP
• Pamela D Smith
• Ronald Thomas Smith, DDS
• Tina Victoria Smith, DDS
• Whitney Smith

• Surgical Physician Assistant in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.