KELLY A MUSCAVITCH (PA) – Physician Assistant, NPI 1679963821
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for KELLY A MUSCAVITCH (PA)
5875 E RIVERSIDE BLVD
ROCKFORD, IL 611144937
Phone: (815) 398-9491
Fax: (815) 381-7498
Type: Mailing
750 E TERRA COTTA AVE
SUITE C
CRYSTAL LAKE, IL 600143621
Phone: (815) 398-9491
Fax: (815) 381-7498
Type: Location
1000 N WESTMORELAND RD
LAKE FOREST, IL 600451658
Phone: (847) 582-2134
Fax: (847) 535-7285
Type: Mailing
22285 N PEPPER RD STE 201
LAKE BARRINGTON, IL 600102540
Phone: (847) 382-5080
Fax: (847) 382-0923
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $87.
Total Amount is formed as General ($87) + Research ($0) + Ownership ($0) = $87.
Last reported payment date: 2023-12-12 • Largest payer in this snapshot: Sumitomo Pharma America, Inc. ($87).
Total Amount
$87
General + Research + Ownership
Payments
4
Total payment records
General Amount
$87
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-12-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Sumitomo Pharma America, Inc. | $87 |
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: 2015-05-06
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 |
|---|---|---|---|---|
| I20150506002150 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61114)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IL | |
| Diagnostic Radiology, Interventional Radiology | IL | |
| P A T H O L O G Y | IL | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | IL | |
| G A S T R O E N T E R O L O G Y | IL | |
| Internal Medicine | IL | |
| Cardiac Electrophysiology, Cardiovascular Disease (Cardiology), Internal Medicine | MN | |
| - | IL | |
| Physical Therapist In Private Practice | IL | |
| Nurse Practitioner | IL |
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