Individual provider Active NPI

Kathleen Corkery, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1639522337
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085005830 Issued in IL
Practice address
1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone
(312) 942-9217
NPI assigned
Jul 18, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085005830 IL Primary

Addresses

Primary practice location

1653 W Congress Pkwy
Chicago, IL 60612-3833

Mailing address

541 W Oakdale Ave
Apt 513
Chicago, IL 60657-5752
Phone (309) 310-4512

Other names 1

  • Katie Moore Other name

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
I20160929001702 IL Practitioner - Physician Assistant 7911294251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1620 W Harrison St
Chicago, IL 60612-3801

1700 W Van Buren St
Chicago, IL 60612-5500
Phone (312) 563-2875

Hospital & facility affiliations

  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085005830ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Center CurrentSince Oct 1, 2020 Accepting new patients
Rush University Medical Group CurrentSince Oct 1, 2020 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1725 W Harrison St
Ste 1118
Chicago, IL 60612
Phone (312) 942-5936

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

1725 W Harrison St
Ste 1106
Chicago, IL 60612
Phone (312) 563-2144

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

Interoperability endpoints

  • Direct secure messaging: kmoore96059@direct.rush.rush-health.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1639522337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W OAKDALE AVE",
            "address_2": "APT 513",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575752",
            "telephone_number": "309-310-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 W CONGRESS PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123833",
            "telephone_number": "312-942-9217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORKERY",
        "first_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "MOORE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.