DR. DEREK JOSEPH KELLY (NPI# 1407989106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407989106 |
| Entity Type | Individual |
| Full Name | DR. DEREK JOSEPH KELLY |
| Credential | MD |
| Practice Address |
2740 W Foster Ave Suite 209 Chicago IL 60625-3500 |
| Practice Telephone | 7732933510 |
| Practice Fax Number | 7732933514 |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036063365 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS | 0031600421 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043649239 | Derek Kelly | Physical Therapist | 3800 Shamrock Dr, Charlotte, NC 28215-3220 | 2013-11-07 |
| 1164622007 | Derek Keith Kelly | Emergency Medicine | 1400 8th Ave, Fort Worth, TX 76104-4110 | 2007-07-19 |
| 1649499971 | Derek M Kelly | Orthopaedic Surgery | 1458 W Poplar Ave, Suite 100, Collierville, TN 38017-0630 | 2007-04-25 |
| 1306808597 | Derek Kelly | Dentist | 1597 Washington Pike Ste A5, Bridgeville, PA 15017-2881 | 2006-04-04 |
| Street Address |
2740 W FOSTER AVE SUITE 209 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60625-3500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114926573 | Ashwin M Shah, Md, Sc | Surgery | 2740 W Foster Ave, Chicago, IL 60625-3500 | 2005-07-19 |
| 1194279463 | Kirschenbaum Dermatology LLC | Dermatology | 2740 W Foster Ave, Suite# 305, Chicago, IL 60625-3510 | 2016-08-04 |
| 1831544378 | Lutheran Social Services of Il | Counselor | 2740 W Foster Ave, Ste 103, Chicago, IL 60625-3500 | 2016-05-03 |
| 1427422625 | Sahned Jaafar | Surgery | 2740 W Foster Ave, Ll7, Chicago, IL 60625 | 2015-11-25 |
| 1003289356 | Sofia Carleen Jimenez | Psychologist | 2740 W Foster Ave, Suite 412, Chicago, IL 60625-3500 | 2015-11-09 |
| 1174903512 | Independent Physicians' Aco of Chicago, LLC | Internal Medicine | 2740 W Foster Ave, Suite 116, Chicago, IL 60625-3500 | 2015-06-01 |
| 1205273190 | Hilary Bayley Brown | Social Worker | 2740 W Foster Ave, Ste 412, Chicago, IL 60625-3500 | 2013-05-31 |
| 1891067666 | Resurrection Services | General Practice | 2740 W Foster Ave, Suite 113, Chicago, IL 60625-3500 | 2012-02-08 |
| 1215223581 | Nina Patel | Internal Medicine | 2740 W Foster Ave, Ste 401, Chicago, IL 60625-3591 | 2011-06-24 |
| 1073819165 | Federer Surgical Services Ltd | Surgery | 2740 W Foster Ave, Suite 213, Chicago, IL 60625-3500 | 2011-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726615 | B Wise Rehabilitation Pllc | Physical Therapist | 4754 N Lincoln Ave, Fl 1, Chicago, IL 60625 | 2020-10-07 |
| 1700490448 | Anita Saini | Pharmacist | 5140 N California Ave, Chicago, Il 60625, Chicago, IL 60625 | 2020-09-01 |
| 1699303164 | Marina Karamanis | Student in an Organized Health Care Education/Training Program | Swedish Hospital, 5140 N. California Ave, Chicago, IL 60625 | 2020-03-31 |
| 1063050227 | Jacqueline Guadalupe Saldana | Behavioral Analyst | 8616 W Catalpa Ave, Suite 1106, Chicago, IL 60625 | 2019-12-18 |
| 1912557802 | Six Senses Therapy LLC | Social Worker | 2334 W. Lawrence Avenue, Suite 204c, Chicago, IL 60625 | 2019-09-13 |
| 1982266110 | Noreen Randhawa | Family Medicine | Swedish Hospital Part of North Shore, 5145 N. California Ave., Chicago, IL 60625 | 2019-07-09 |
| 1376102202 | Nita Gupta | Student in an Organized Health Care Education/Training Program | Graduate Medical Education Department, 5145 N. California Ave, Chicago, IL 60625 | 2019-06-13 |
| 1841763471 | Alexandra Taskier | Counselor | 5359 N Bowmanville Ave., Chicago, IL 60625 | 2019-01-07 |
| 1013490143 | Paula Bielnicka | Pharmacist | Swedish Covenant Hospital - Pharmacy, 5140 N California Ave, Chicago, IL 60625 | 2018-09-14 |
| 1902397078 | Rebecca Abraham | Hospitalist | 5145 N California Ave Ofc M331, Chicago, IL 60625 | 2018-05-24 |
| Find all providers in zip 60625 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1124645700 | Timothy Alan Williams Jr. | Family Medicine | 1625 E 75th St Fl 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1194340026 | Kaysha Lynne Ribao | Family Medicine | 2116 S Springfield Ave, Chicago, IL 60623-2465 | 2020-06-16 |
| 1932724341 | Toni Kurian | Family Medicine | 1550 S Indiana Ave Apt 407, Chicago, IL 60605-4822 | 2020-06-11 |
| 1528689486 | Thurman J Robertson | Family Medicine | 1950 W. Polk Street, 7th Floor, Chicago, IL 60612-3714 | 2020-05-01 |
| 1629697297 | Lyndsey Danielle Johnson | Family Medicine | 2804 W Walton St, Chicago, IL 60622-4450 | 2020-04-13 |
| 1730708884 | Iruoma Genevieve Nwangwu | Family Medicine | 1950 W Polk Street, Chicago, IL 60612-3714 | 2020-04-09 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.