NPIMap

Individual provider Active NPI

Kenneth Nelson, MD

  • Family Medicine Physician
  • Westchester, IL
National Provider Identifier
1700838745
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36069123 Issued in IL
Practice address
2434 Wolf Rd
Westchester, IL 60154-5634
Phone
(630) 856-6865
Fax
(630) 856-6813
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36069123 IL Primary

Addresses

Primary practice location

2434 Wolf Rd
Westchester, IL 60154-5634

Mailing address

911 N Elm St
Suite 215
Hinsdale, IL 60521-3634
Phone (630) 856-6865

Other identifiers 1

IdentifierTypeStateIssuer
36069123MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kenneth.nelson.1@380.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110224000150 IL Practitioner - Family Practice 2264415082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Medicine and Surgery, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Partners, Inc.Group PAC ID 0244135762, 253 clinicians

Practice addresses (Care Compare)

2434 Wolf Rd
Westchester, IL 60154-5634
Phone (708) 562-5430

396 Remington Blvd
Bolingbrook, IL 60440-4311

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-7044

Hospital & facility affiliations

  • Uchicago Medicine Adventhealth Home Care Home health agency, La Grange, IL, CCN 147207
  • Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122
  • Uchicago Medicine Adventhealth la Grange Hospital, La Grange, IL, CCN 140065
  • Uchicago Medicine Adventhealth Bolingbrook Hospital, Bolingbrook, IL, CCN 140304
  • Elmhurst Memorial Hospital Hospital, Elmhurst, IL, CCN 140200
  • Uchicago Medicine Adventhealth Glenoaks Hospital, Glendale Heights, IL, CCN 140292

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36069123ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners, Inc. Current Accepting new patients
Adventist Health Partners,Inc Family Medicine CurrentSince Jan 15, 2017 Accepting new patients
Adventist Health Partners, Inc Family Medicine CurrentSince Jan 15, 2017 Accepting new patients
Adventist Health Partners,Inc Family Medicine Past Accepting new patients

Locations

1000 Remington Blvd
Ste 200
Bolingbrook, IL 60440
Phone (630) 312-7755

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

2434 Wolf Rd
#C
Westchester, IL 60154
Phone (708) 562-5430

2434 Wolf Rd
Westchester, IL 60154
Phone (630) 856-6800

Interoperability endpoints

  • Direct secure messaging: knelson1240987@adventhealth.direct-ci.com

Organizations & group practices 4

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 9

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1700838745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 N ELM ST",
            "address_2": "SUITE 215",
            "city": "HINSDALE",
            "state": "IL",
            "postal_code": "605213634",
            "telephone_number": "630-856-6865",
            "fax_number": "630-856-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2434 WOLF RD",
            "city": "WESTCHESTER",
            "state": "IL",
            "postal_code": "601545634",
            "telephone_number": "630-856-6865",
            "fax_number": "630-856-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36069123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36069123",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kenneth.nelson.1@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "2434 Wolf Rd",
            "city": "Westchester",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601545634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Westchester, IL

Sources for this page

Verify at the official NPI Registry.