Kelly L Magoon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1848 Daimler Rd
Rockford, IL 61112-1019

Phone

(815) 398-9100

Fax

(815) 986-6770

NPI assigned

Jul 7, 2014

Last updated

Jul 7, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Javon Bea Hospital Hospital, Rockford, IL, CCN 140239

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmagoon51018@direct.mhemail.org

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.

• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Javon Bea Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1629118609
  Care Compare affiliation

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1811303217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGOON",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Maduakor
• Alaeddin Ali Maeza
• Dennis D. Magdadaro, NP-C
• Kathleen Magill
• Christa Magnuson, RBT
• Karl E. Magsamen, M.D.
• Arvind Mahatme, M.D.
• Karen Maher, FNP
• Fiza Ramlal Maheshwari
• D Maheswari, P.T.

• Physician Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.