NPIMap

Individual provider Active NPI

Kathleen Margaret McGovern, PA-C

  • Physician Assistant
  • Lisle, IL
National Provider Identifier
1780130682
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085005947 Issued in IL
Practice address
430 Warrenville Rd # 230
Lisle, IL 60532-1348
Phone
(630) 693-6437
NPI assigned
Aug 30, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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 085005947 IL Primary

Addresses

Primary practice location

430 Warrenville Rd # 230
Lisle, IL 60532-1348

Mailing address

1860 Paysphere Cir
Chicago, IL 60674-1782
Phone (630) 469-2000

Other identifiers 1

IdentifierTypeStateIssuer
4025370OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmcgovern190449@direct.edward.org

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
I20161209000106 IL Practitioner - Physician Assistant 3870873888 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

1401 S California Ave
Chicago, IL 60608-1858
Phone (773) 522-6656

California Ave at 15TH St
Chicago, IL 60608-1858
Phone (773) 542-2000

Hospital & facility affiliations

  • Mt Sinai Hospital Medical Center Hospital, Chicago, IL, CCN 140018
  • Holy Cross Hospital Hospital, Chicago, IL, CCN 140133

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085005947ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Community Foundation Dba Sinai Medical Group CurrentSince Nov 5, 2016 Accepting new patients
Cep America - Illinois, LLP CurrentSince Sep 10, 2017 Accepting new patients
Mount Sinai Community Foundation CurrentSince Nov 5, 2016 Accepting new patients
Cepamerica Illinois LLP CurrentSince Sep 10, 2017 Accepting new patients

Locations

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

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

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

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

Interoperability endpoints

  • Direct secure messaging: kmcgovern190449@direct.edward.org
  • Direct secure messaging: kmcgovern185646@direct.rush.rush-health.com

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.

Hospital & facility affiliations 5

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": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1780130682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606741782",
            "telephone_number": "630-469-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WARRENVILLE RD # 230",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321348",
            "telephone_number": "630-693-6437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOVERN",
        "first_name": "KATHLEEN",
        "middle_name": "MARGARET",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
            "identifier": "4025370",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmcgovern190449@direct.edward.org",
            "affiliation": "N",
            "address_1": "430 Warrenville Rd # 230",
            "city": "Lisle",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605321348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

Verify at the official NPI Registry.