DESTINY KELLAM (MD) – Hospice and Palliative Medicine (Emergency Medicine) Physician, NPI 1033853650
Hospice and Palliative Medicine (Emergency Medicine) Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,847 EMERGENCY MEDICINE in IL
Provider Addresses for DESTINY KELLAM (MD)
2320 E 93rd St
Chicago, IL 606173909
Phone: (773) 967-5430
Fax: (773) 967-4205
Type: Location
25920 AVONDALE ST
INKSTER, MI 481411933
Phone: (313) 539-0082
Type: Mailing
6071 W OUTER DR
DETROIT, MI 482352624
Phone: (313) 966-3300
Type: Location
180 HARVESTER DR STE 110
BURR RIDGE, IL 605276686
Phone: (773) 702-1150
Type: Mailing
5841 S MARYLAND AVE STE MC6098
CHICAGO, IL 606371448
Phone: (855) 702-8222
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-01-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20260121002914 | I | Emergency Medicine | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60617)
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