Individual provider Active NPI

Kristy Patterson, PA

  • Medical Physician Assistant
  • Herscher, IL
National Provider Identifier
1811072663
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
692 N. Maple
Herscher, IL 60941
Phone
(815) 426-2020
NPI assigned
Oct 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X IL Primary

Addresses

Primary practice location

692 N. Maple
Herscher, IL 60941

Mailing address

555 W Court St Ste 410
Kankakee, IL 60901-3675
Phone (815) 937-2284

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
I20050428000316 IL Practitioner - Physician Assistant 7416996525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Group of Kankakee CountyGroup PAC ID 3577462258, 7 clinicians

Practice addresses (Care Compare)

555 E N St
Suite E
Bradley, IL 60915-1232
Phone (815) 929-0858

692 N Maple St
Herscher, IL 60941-9785
Phone (815) 426-2020

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-001812ILMDMedical Physician Assistant

Organizations & group practices 1

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 4

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811072663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W COURT ST STE 410",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013675",
            "telephone_number": "815-937-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 N. MAPLE",
            "city": "HERSCHER",
            "state": "IL",
            "postal_code": "60941",
            "telephone_number": "815-426-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "KRISTY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herscher, IL

Sources for this page

Verify at the official NPI Registry.