ALYSSA BRIE KETCHUM PA-C
NPI 1104200625
Physician Assistant - Surgical in Chicago, IL

Q: What is Alyssa Ketchum's NPI number?

The NPI number for Alyssa Ketchum is 1104200625. It was assigned to this individual provider in the NPPES registry on July 14, 2015. The provider is also known as Alyssa Brie Teasdale.

Q: What is Alyssa Ketchum's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Alyssa Ketchum was last updated on December 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 14, 2015PECOS EnrolledAccepts Medicare Assignment

94.1/100

CMS Quality Rating

676 N SAINT CLAIR ST STE 1900, CHICAGO, IL 60611(312) 926-5354 Get Directions Write a Review

NPPES record last updated: December 17, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Alyssa Brie Ketchum Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALYSSA BRIE KETCHUM PA-C (NPI 1104200625) is an individual surgical provider in Chicago, Illinois, licensed in Illinois (085005549) and active in the NPI registry since July 2015. She is enrolled in Medicare PECOS, is affiliated with Northwestern Memorial Hospital, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1104200625

Entity TypeIndividualFemale

Primary Taxonomy363AS0400X

Provider Legal NameALYSSA BRIE KETCHUMCredential: PA-C

Location Address676 N SAINT CLAIR ST STE 1900Chicago, IL 60611-2986

Mailing Address676 N Saint Clair St Ste 1900Chicago, IL 60611-2986 · (312) 926-5354

Phone(312) 926-5354

Sole ProprietorNo

Medical School CMSOtherGraduated 2015

Enumeration DateJuly 14, 2015

Last NPPES UpdateDecember 17, 2018

✔ NPI 1104200625 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in IL · 085005549

676 N SAINT CLAIR ST STE 1900, Chicago, IL 60611

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Other Names 1

Former Name (1)Alyssa Brie Teasdale

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Alyssa Brie Ketchum Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345542700

PECOS Enrollment IDI20151231001980

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Diagnostic exam of voice box using a flexible endoscope 31575

This procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.

37 services37 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

28 services28 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

26 services24 patients

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

21 services21 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

15 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northwestern Memorial Hospital

Acute Care Hospitals · Chicago, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140281

Location251 E Huron StChicago, IL 60611 · Cook County

Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

94.1/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

82.59

Promoting Interoperability

100

Improvement Activities

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRIAN MOYER PA-C

Physician Assistant (Surgical)