NPIMap

Organization Active NPI

Patrick J Kennelly and Associates P C

  • Clinical Psychologist
  • Schaumburg, IL
National Provider Identifier
1750430476
Registry record updated Apr 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PATRICK J KENNELLY AND ASSOCIATES P C
Practice address
1340 Remington Rd
Suite N
Schaumburg, IL 60173-4830
Phone
(847) 310-8578
Fax
(847) 310-9651
NPI assigned
Jan 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2011

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

Authorized official

Name
Dr. Patrick J Kennelly, PH.D.NPI 1720078157
Title
Director
Phone
(847) 310-8578

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1340 Remington Rd
Suite N
Schaumburg, IL 60173-4830

Mailing address

1340 Remington Rd
Suite N
Schaumburg, IL 60173-4830
Phone (847) 310-8578

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050916000154 IL Part B Supplier - Clinic/Group Practice 2860425113 Receives reassigned benefits from 6 practitioners
Practice locations: Schaumburg, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302825600000",
    "number": "1750430476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 REMINGTON RD",
            "address_2": "SUITE N",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734830",
            "telephone_number": "847-310-8578",
            "fax_number": "847-310-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 REMINGTON RD",
            "address_2": "SUITE N",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734830",
            "telephone_number": "847-310-8578",
            "fax_number": "847-310-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK J KENNELLY AND ASSOCIATES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2011-04-15",
        "status": "A",
        "authorized_official_last_name": "KENNELLY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-310-8578",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.