Active NPI
Kelly Dineen
- Specialist
- Chicago, IL
National Provider Identifier
1871592543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 071006880
- Practice address
- 1 E Delaware PL Ste 310
Chicago, IL 60611-4962 - Phone
- (773) 720-1623
- NPI assigned
- Jul 15, 2005
- Last updated
- Apr 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 071006880 | IL | Primary |
Addresses
Primary practice location
1 E Delaware PL Ste 310
Chicago, IL 60611-4962
Mailing address
5250 Grand Ave # 14-390
Gurnee, IL 60031-1877
Phone (847) 212-1015
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090512000082 | IL | Practitioner - Clinical Psychologist | 9133277619 | Practice locations: Chicago, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Northwestern University Feinberg Medical School, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1 E Delaware PL
Suite 310
Chicago, IL 60611-4962
Phone (773) 720-1623
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1871592543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5250 GRAND AVE # 14-390",
"city": "GURNEE",
"state": "IL",
"postal_code": "600311877",
"telephone_number": "847-212-1015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E DELAWARE PL STE 310",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114962",
"telephone_number": "773-720-1623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DINEEN",
"first_name": "KELLY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-15",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "071006880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; 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.