KEELY E PEDERSEN (PA-C) – Physician Assistant, NPI 1619228624
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for KEELY E PEDERSEN (PA-C)
900 RAND RD
SUITE 300
DES PLAINES, IL 600162359
Phone: (847) 324-3976
Type: Mailing
720 FLORSHEIM DR
LIBERTYVILLE, IL 600483757
Phone: (847) 247-4000
Type: Location
1000 N WESTMORELAND RD
LAKE FOREST, IL 600451658
Phone: (847) 535-6150
Fax: (847) 535-7801
Type: Mailing
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: 2013-01-31
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 |
|---|---|---|---|---|
| I20130131000096 | I | Physician Assistant | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 82 | 69 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 54 | 54 | $0 |
| 81003 | Automated urinalysis test | 24 | 19 | $0 |
| 71046 | X-ray of chest, 2 views | 20 | 20 | $0 |
| 87637 | Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19), influenza virus types a and b, and respiratory syncytial virus | 12 | 12 | $0 |
Insurance plans in this area (ZIP 60016)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | IL | |
| Nurse Practitioner | IL | |
| Physician Assistant | IL | |
| Nurse Practitioner | WI | |
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| Nurse Practitioner | IL | |
| - | IL | |
| Physician Assistant | IL |
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