Individual provider Active NPI

Kelsey Anne Renner, PA-C

  • Physician Assistant
  • Warrenville, IL
National Provider Identifier
1649890559
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085007979 Issued in IL
Practice address
4405 Weaver Pkwy
Warrenville, IL 60555-3269
Phone
(630) 352-5450
Fax
(630) 933-4959
NPI assigned
Apr 21, 2020
Last updated
Nov 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085007979 IL Primary
Physician Assistant 363A00000X NU

Addresses

Primary practice location

4405 Weaver Pkwy
Warrenville, IL 60555-3269

Mailing address

4405 Weaver Pkwy
Warrenville, IL 60555-3269
Phone (630) 352-5450

Other practice location 1

304 Randall Rd
Geneva, IL 60134-4200
Phone (630) 232-0610

Other practice location 2

25 N Winfield Rd Ste 2202
Winfield, IL 60190-1379
Phone (630) 352-5450

Other names 1

  • Kelsey A Knowles 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
I20210112002873 IL Practitioner - Physician Assistant 9335552322 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

25 N Winfield Rd
Winfield, IL 60190-1295

300 Randall Rd
Geneva, IL 60134-4200
Phone (630) 933-4700

304 Randall Rd
Geneva, IL 60134-4200
Phone (630) 307-7799

4405 Weaver Pkwy
Warrenville, IL 60555-3269
Phone (630) 352-5450

4455 Weaver Pkwy
Warrenville, IL 60555-3269
Phone (630) 821-6400

660 N Westmoreland Rd
302 Lake Forest OBGYN
Lake Forest, IL 60045-1673
Phone (312) 926-6146

7 Blanchard Cir
Wheaton, IL 60189-2038

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085007979ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Mar 22, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Oct 1, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Oct 1, 2025 Accepting new patients
Central Dupage Physician Group CurrentSince Mar 22, 2023 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

304 Randall Rd
Geneva, IL 60134
Phone (630) 232-0610

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4405 Weaver Pkwy
Warrenville, IL 60555
Phone (630) 352-5450

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

25 N Winfield Rd
Ste 2202
Winfield, IL 60190
Phone (630) 352-5450

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 3

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": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1649890559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 WEAVER PKWY",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553269",
            "telephone_number": "630-352-5450",
            "fax_number": "630-933-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 WEAVER PKWY",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553269",
            "telephone_number": "630-352-5450",
            "fax_number": "630-933-4959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "304 Randall Rd",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601344200",
            "country_code": "US",
            "telephone_number": "630-232-0610",
            "fax_number": "630-232-0675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 N Winfield Rd Ste 2202",
            "address_purpose": "LOCATION",
            "city": "Winfield",
            "state": "IL",
            "postal_code": "601901379",
            "country_code": "US",
            "telephone_number": "630-352-5450",
            "fax_number": "630-933-4959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENNER",
        "first_name": "KELSEY",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-21",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007979",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "KNOWLES",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Warrenville, IL

Sources for this page

Verify at the official NPI Registry.