Individual provider Active NPI

Kenneth Sherry, AGACNP

  • Nurse Practitioner
  • Oak Lawn, IL
National Provider Identifier
1699213728
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.015815 Issued in IL
Practice address
4440 W 95TH St
Oak Lawn, IL 60453-2600
Phone
(708) 684-8000
NPI assigned
Feb 9, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 041-410653 IL
Nurse Practitioner 363L00000X 209.015815 IL Primary

Addresses

Primary practice location

4440 W 95TH St
Oak Lawn, IL 60453-2600

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address ksherry205687@direct.myadvocateaurora.org Direct

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
I20170503001928 IL Practitioner - Nurse Practitioner 1456638220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Rush Medical College of Rush University, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advocate Health and Hospitals CorporationGroup PAC ID 7810800935, 3,081 clinicians

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

4440 W 95TH St
Oak Lawn, IL 60453-2600

Hospital & facility affiliations

  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.015815ILMDNurse Practitioner
041-410653ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corporation CurrentSince Jun 21, 2017 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2023 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

28592 Network Pl
Chicago, IL 60673

4440 W 95th St
Ste Aip
Oak Lawn, IL 60453
Phone (708) 684-8000

4440 W 95th St
Oak Lawn, IL 60453
Phone (708) 346-5520

Interoperability endpoints

  • Direct secure messaging: ksherry205687@direct.myadvocateaurora.org

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": "1486598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1699213728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "708-684-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERRY",
        "first_name": "KENNETH",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-09",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "041-410653",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.015815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksherry205687@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4440 W 95th St",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.