Individual provider Active NPI

Kolette A Kirkenmeier, PA-C

  • Physician Assistant
  • Aurora, IL
National Provider Identifier
1659639599
Registry record updated Jul 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.004323 Issued in IL
Practice address
1325 N Highland Ave
Aurora, IL 60506-1449
Phone
(630) 859-2222
NPI assigned
Apr 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2015

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 085.004323 IL Primary

Addresses

Primary practice location

1325 N Highland Ave
Aurora, IL 60506-1449

Mailing address

1325 N Highland Ave
Aurora, IL 60506-1449
Phone (630) 859-2222

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
I20150716001262 IL Practitioner - Physician Assistant 6204082258 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

3626 N Sheridan Rd
Peoria, IL 61604-1401
Phone (309) 308-5100

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.004323ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP CurrentSince Oct 1, 2016 Accepting new patients
Cepamerica Illinois LLP CurrentSince Oct 1, 2016 Accepting new patients
Central Dupage Hospital Association CurrentSince Oct 19, 2016 Accepting new patients
Osf Multi-Specialty Group CurrentSince May 6, 2019 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

10408 N Centerway Dr
Ste C
Peoria, IL 61615

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1335657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1659639599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605061449",
            "telephone_number": "630-859-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605061449",
            "telephone_number": "630-859-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKENMEIER",
        "first_name": "KOLETTE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-29",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.