Marissa Elaine Kelley, RD, CDCES, NBC-HWC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.005904 Issued in IL

Practice address

23W308 Westchester CT
Glen Ellyn, IL 60137-6546

Phone

(617) 833-3783

NPI assigned

Jan 9, 2025

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 FL

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medical Dietitians LLCGroup PAC ID 8820469208, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Medical Dietitians LLC

  • Registered Dietitian
  • St Pete Beach, FL
  • NPI 1053028415

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Walsh Nutrition Group, Inc.

  • Metabolic Nutrition Registered Dietitian
  • Burr Ridge, IL
  • NPI 1992299788
  NPD (past)

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

{
    "created_epoch": "1736380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1942010178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23W308 WESTCHESTER CT",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376546",
            "telephone_number": "617-833-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23W308 WESTCHESTER CT",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376546",
            "telephone_number": "617-833-3783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARISSA",
        "middle_name": "ELAINE",
        "credential": "RD, CDCES, NBC-HWC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-09",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.005904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Young Kang, MD
• Ann B Karch, M.D.
• Karen T. Watkins & Associates Inc.
• Yasir Kazmi, MD
• Susan Elizabeth Kelenyi, D.C.
• Rhonda K Kelloway, LCSW
• Catherine Ann Kelly, LPC, ATR
• James Michael Kelly, O.D.
• Brenda Kendziera, LPC
• Robert Joseph Kennedy

• Registered Dietitian in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.