Individual provider Active NPI

Mary Grace Kaleta, APN

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1679180921
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209021753 Issued in IL
Practice address
675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Phone
(312) 664-3278
Fax
(312) 695-5774
NPI assigned
Sep 29, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 209021753 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969

Mailing address

675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Phone (312) 664-3278

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
I20201130000912 IL Practitioner - Nurse Practitioner 2365853116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1630 Sherman Ave
Evanston, IL 60201-3711

21202 Owens Rd
Suite 101
Mokena, IL 60448-2001
Phone (630) 315-6930

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

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209021753ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation Single Specialty CurrentSince Nov 11, 2020 Accepting new patients
Northwestern Medical Faculty Foundation Single Specialty CurrentSince Nov 11, 2020 Accepting new patients
Central Dupage Physician Group Single Specialty Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

675 N Saint Clair St
Ste 19-100
Chicago, IL 60611
Phone (312) 664-3278

675 N Saint Clair St
Chicago, IL 60611
Phone (312) 664-3278

251 E Huron St
Chicago, IL 60611

675 N Saint Clair St
Ste 19100
Chicago, IL 60611
Phone (312) 664-3278

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

21202 Owens Rd
Ste 201
Mokena, IL 60448
Phone (779) 334-0010

12251 S 80th Ave
#1520
Palos Heights, IL 60463

Organizations & group practices 3

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 6

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": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1679180921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 19-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115969",
            "telephone_number": "312-664-3278",
            "fax_number": "312-695-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 19-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115969",
            "telephone_number": "312-664-3278",
            "fax_number": "312-695-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALETA",
        "first_name": "MARY",
        "middle_name": "GRACE",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209021753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.