NPIMap

Individual provider Active NPI

Carolyn Kelly, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Bolingbrook, IL
National Provider Identifier
1619264041
Registry record updated Aug 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016.005524 Issued in IL
Practice address
396 Remington Blvd Ste 370
Bolingbrook, IL 60440-4302
Phone
(630) 418-6601
Fax
(630) 312-2223
NPI assigned
Jul 6, 2011
Last updated
Aug 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X 016005524 IL
Podiatrist 213E00000X 135000752 IL
Foot & Ankle Surgery Podiatrist 213ES0103X 016.005524 IL Primary

Addresses

Primary practice location

396 Remington Blvd Ste 370
Bolingbrook, IL 60440-4302

Mailing address

396 Remington Blvd Ste 370
Bolingbrook, IL 60440-4302
Phone (630) 418-6601

Other practice location 1

256 Tudor Court
Bolingbrook, IL 60440-2056
Phone (630) 294-0810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140618002303 IL Practitioner - Podiatry 0941424675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook CountyGroup PAC ID 2860398088, 770 clinicians

Practice addresses (Care Compare)

1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue16
Removal of skin lesions1-10
Removal of nail tissue84
Removal or shaving of skin growth48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
135000752ILMDPodiatrist
016.005524ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Current Accepting new patients
Elgin Foot & Ankle Center, S.C. Podiatrist CurrentSince Jul 14, 2014 Accepting new patients
Cook County CurrentSince May 19, 2022 Accepting new patients
Cook County CurrentSince May 19, 2022 Accepting new patients
John H Stroger Jr Hospital Cook County Past Accepting new patients

Locations

396 Remington Blvd
Ste 370
Bolingbrook, IL 60440
Phone (630) 418-6601

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

750 Fletcher Dr
Ste 300
Elgin, IL 60123
Phone (847) 741-3127

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1619264041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 REMINGTON BLVD STE 370",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404302",
            "telephone_number": "630-418-6601",
            "fax_number": "630-312-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 REMINGTON BLVD STE 370",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404302",
            "telephone_number": "630-418-6601",
            "fax_number": "630-312-2223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "256 Tudor Court",
            "address_purpose": "LOCATION",
            "city": "Bolingbrook",
            "state": "IL",
            "postal_code": "604402056",
            "country_code": "US",
            "telephone_number": "630-294-0810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CAROLYN",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-06",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IL",
            "license": "016005524",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "135000752",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016.005524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.