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KELLY DIETRICK
NPI 1265393003
Physician Assistant in Chicago, IL

Active since November 20, 2025PECOS EnrolledAccepts Medicare Assignment
6140 N BROADWAY ST, CHICAGO, IL 60660(224) 795-3521 Get Directions Write a Review

NPPES record last updated: November 20, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kelly Dietrick NPPES

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

KELLY DIETRICK (NPI 1265393003) is an individual physician assistant in Chicago, Illinois, licensed in Illinois (085-011805) and active in the NPI registry since November 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1265393003
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKELLY DIETRICK
Location Address6140 N BROADWAY STChicago, IL 60660-2538
Mailing Address1033 E Talbot StArlington Heights, IL 60004-5072 · (224) 795-3521
Phone(224) 795-3521
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateNovember 20, 2025
NPPES CertifiedNovember 20, 2025
✔ NPI 1265393003 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in IL · 085-011805
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
6140 N BROADWAY ST, Chicago, IL 60660
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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

Kelly Dietrick 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 ID6709362742
PECOS Enrollment IDI20260109001676
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60660 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

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

BLAKE CHILDRESS PA-C
Physician Assistant
6140 N BROADWAY ST
CHICAGO, IL 60660
Cook County (773) 564-9206

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Dietrick's NPI number?

The NPI number for Kelly Dietrick is 1265393003. It was assigned to this individual provider in the NPPES registry on November 20, 2025.

Where is Kelly Dietrick located?

Kelly Dietrick practices at 6140 N Broadway St, Chicago, IL 60660. The listed phone number is (224) 795-3521.

What is Kelly Dietrick's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kelly Dietrick enrolled in Medicare?

Yes. Kelly Dietrick is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Kelly Dietrick was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.