Active NPI
Kelly Roehl
- Registered Dietitian
- Chicago, IL
National Provider Identifier
1972926210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.005110
- Practice address
- 1653 W Congress Pkwy
Chicago, IL 60612-3833 - Phone
- (312) 942-0513
- NPI assigned
- Jan 22, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.005110 | IL | Primary |
Addresses
Primary practice location
1653 W Congress Pkwy
Chicago, IL 60612-3833
Mailing address
525 S Dearborn St
Apt 309
Chicago, IL 60605-1524
Phone (312) 942-0513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.005110 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390348800000",
"number": "1972926210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 S DEARBORN ST",
"address_2": "APT 309",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606051524",
"telephone_number": "312-942-0513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1653 W CONGRESS PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123833",
"telephone_number": "312-942-0513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEHL",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-22",
"last_updated": "2014-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.005110",
"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 Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.