NPIMap

Organization Active NPI

KND Development 59 LLC

  • Hospitalist Physician
  • Northlake, IL
National Provider Identifier
1598094906
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
KND DEVELOPMENT 59 LLC
Practice address
365 E North Ave
Northlake, IL 60164-2628
Phone
(708) 345-8100
Fax
(833) 501-9731
NPI assigned
Dec 14, 2009
Organization subpart
Yes
Parent organization
KINDRED HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Authorized official

Name
Linda L Fisher
Title
DVP Revenue Cycle
Phone
(502) 596-7358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

365 E North Ave
Northlake, IL 60164-2628

Mailing address

680 S 4TH St
Louisville, KY 40202-2407
Phone (502) 596-7358

Other identifiers 1

IdentifierTypeStateIssuer
IL3881OtherILMEDICARE

Other names 1

  • 4010 KH CHICAGO NORTHLAKE Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101021000962 IL Part B Supplier - Clinic/Group Practice 3678602802 Receives reassigned benefits from 116 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Northlake, IL; Oak Brook, IL; Sycamore, IL

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
KND Development 59 LLC78 organizations share this tax ID, including this one
Part of
Presence Covenant Medical Center

Organizations with this tax ID in the same state 3

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612915200000",
    "number": "1598094906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S 4TH ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-7358",
            "fax_number": "833-501-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 E NORTH AVE",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601642628",
            "telephone_number": "708-345-8100",
            "fax_number": "833-501-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KND DEVELOPMENT 59 LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KINDRED HEALTHCARE, LLC",
        "enumeration_date": "2009-12-14",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DVP REVENUE CYCLE",
        "authorized_official_telephone_number": "502-596-7358"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "IL3881",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4010 KH CHICAGO NORTHLAKE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Northlake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.