Keith Michael Ladendorf, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085002545 Issued in IL

Practice address

7447 W Talcott Avenue
Suite 512
Chicago, IL 60631

Phone

(847) 788-1553

Fax

(773) 577-8187

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IN, WI3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cardiac Surgery Associates SCGroup PAC ID 2860304102, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amita Health Resurrection Medical Center Hospital, Chicago, IL, CCN 140117
• Trinity Rock Island Hospital, Rock Island, IL, CCN 140280

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kladendorf251764@direct.myadvocateaurora.org
• Direct secure messaging: kladendorf214226@direct.franciscanalliance.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.

• Cardiac Surgery Associates SC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Downers Grove, IL
  • NPI 1043269160

  IN

  Medicare reassignment Care Compare group NPD
• Franciscan Physician Network

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1225327984
  Medicare reassignment NPD
• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment NPD (past)
• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991
  NPD
• Franciscan Physician Network

  • Clinic/Center
  • Lafayette, IN
  • NPI 1992543250
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Resurrection Medical Center - Chicago LLC

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1811735228
  Care Compare affiliation
• Trinity Medical Center

  • General Acute Care Hospital
  • Rock Island, IL
  • NPI 1316047632
  Care Compare affiliation

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1619092095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 WARRENVILLE ROAD",
            "address_2": "SUITE 280",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60515",
            "telephone_number": "630-324-7911",
            "fax_number": "630-324-7942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7447 W TALCOTT AVENUE",
            "address_2": "SUITE 512",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60631",
            "telephone_number": "847-788-1553",
            "fax_number": "773-577-8187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 St Francis Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479054940",
            "country_code": "US",
            "telephone_number": "776-775-2800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LADENDORF",
        "first_name": "KEITH",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085002545",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-002545",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Lada, LCSW
• Andras Ladanyi, M.D., PH.D.
• Sydney Ladas, MD
• Zoe Ladas, LPC
• Indrig Ladden, LCSW
• Nicole Laderberg Bowers, PSYD
• Amy M Ladewski, PA-C
• Michael Edward Ladewski, D.O.
• Kimball H Ladien, M.D.
• Tunji Ladipo, MD

• Surgical Physician Assistant in Chicago, IL
• Providers in Chicago, 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 Jan 23, 2023; 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.