Mary Louise Kelly, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036077560 Issued in IL

Practice address

1125 Westgate St
Oak Park, IL 60301-1007

Phone

(708) 848-0040

Fax

(708) 848-2931

NPI assigned

Oct 17, 2006

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

Other identifiers 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Edward Health Ventures

  • Multi-Specialty Clinic/Center
  • Bolingbrook, IL
  • NPI 1962452912
  Medicare reassignment NPD
• Dr Mary Kelly

  • Family Medicine Physician
  • River Forest, IL
  • NPI 1164683157
  NPD (past) Authorized official
• Edward Health Ventures

  • Neurology Physician
  • Naperville, IL
  • NPI 1063830081
  NPD
• Mary L. Kelly, D.O., S.C.

  • Medical Specialty Clinic/Center
  • River Forest, IL
  • NPI 1497903314
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1912087560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 WESTGATE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011007",
            "telephone_number": "708-848-0040",
            "fax_number": "708-848-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 WESTGATE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011007",
            "telephone_number": "708-848-0040",
            "fax_number": "708-848-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036077560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2027403",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362182170",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "01625396",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reem Keilani, LCSW
• Vanessa Keir, RDN
• Jordan R Keller, FNP-BC
• Lisa Keller
• Robert Keller
• Kimberly Kempf, PT
• Jennifer Kennedy, LCSW
• Kate Kennedy, C-SLPA
• William J. Kern
• Alexis Cheyenne Kessinger, DPT

• Family Medicine Physician in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.