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KELLY M BROEDERDORF REGISTERED NURSE
NPI 1952023459
Nurse Practitioner in Woodstock, IL

Active since September 13, 2022PECOS EnrolledAccepts Medicare Assignment
3707 DOTY RD STE CANDD, WOODSTOCK, IL 60098(815) 338-6600(815) 206-1086 Get Directions Write a Review

NPPES record last updated: June 10, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 10, 2024, Sep 13, 2022 (2 updates tracked since 2022).

About Kelly M Broederdorf Registered Nurse NPPES

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

KELLY M BROEDERDORF REGISTERED NURSE (NPI 1952023459) is an individual nurse practitioner in Woodstock, Illinois, licensed in Illinois (209027210) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS, is affiliated with Northwestern Medicine Mchenry, and maintains a secondary practice location in Lincolnshire.

NPPES Registry Identity

NPI1952023459
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameKELLY M BROEDERDORFCredential: REGISTERED NURSE
Location Address3707 DOTY RD STE CANDDWoodstock, IL 60098-7530
Mailing Address3707 Doty Rd Ste CanddWoodstock, IL 60098-7530 · (815) 338-6600 · Fax (815) 206-1086
Phone(815) 338-6600
Fax(815) 206-1086
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateSeptember 13, 2022
Last NPPES UpdateJune 10, 20242 updates tracked since enumeration
NPPES CertifiedJune 10, 2024
✔ NPI 1952023459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in IL · 209027210
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedRegistered Nurse · OncologyTaxonomy 163WX0200X · License 041.387373 (IL)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 209-027210 (IL)
3707 DOTY RD STE CANDD, Woodstock, IL 60098
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Secondary Practice Location 1

Location 1100 Village Grn Ste 120Lincolnshire, IL 60069-3095 · Phone (847) 634-1766 · Fax (847) 634-2894

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 M Broederdorf Registered Nurse 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 ID7113382987
PECOS Enrollment IDI20230501000491
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 8

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.

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.
111 services99 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
48 services48 patients
Telephone medical discussion with physician, 21-30 minutes 99443
This service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.
35 services22 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.
32 services32 patients
Routine electrocardiogram (ecg) using at least 12 leads with tracing 93005
An Electrocardiogram (ECG) is a simple, painless test that records the heart's electrical activity. Using 12 leads attached to your skin, it generates a tracing of your heart rhythm. It helps detect any heart problems by showing the timing and strength of electrical signals passing through each part of your heart.
19 services19 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
19 services19 patients

Hospital Affiliations CMS Care Compare 3

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

Northwestern Medicine Mchenry

Acute Care Hospitals · Mchenry, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140116
Location4201 Medical Center DriveMchenry, IL 60050 · Mc Henry County
Emergency services Birthing friendly

Northwestern Lake Forest Hospital

Acute Care Hospitals · Lake Forest, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140130
Location1000 N Westmoreland RoadLake Forest, IL 60045 · Lake County
Emergency services Birthing friendly

Northwestern Medicine Central Dupage Hospital

Acute Care Hospitals · Winfield, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140242
Location25 North Winfield RoadWinfield, IL 60190 · Du Page County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60098 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
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 2

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

DR. JOSEPH S EMMONS M.D.
Internal Medicine
3707 DOTY RD STE CANDD
WOODSTOCK, IL 60098
McHenry County (815) 338-6600
SARAH LATORIA APRN, CNP
Nurse Practitioner
3707 DOTY RD STE CANDD
WOODSTOCK, IL 60098
McHenry County (815) 338-6600

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 Broederdorf's NPI number?

The NPI number for Kelly Broederdorf is 1952023459. It was assigned to this individual provider in the NPPES registry on September 13, 2022.

Where is Kelly Broederdorf located?

Kelly Broederdorf practices at 3707 Doty Rd Ste Candd, Woodstock, IL 60098. The listed phone number is (815) 338-6600.

What is Kelly Broederdorf's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Kelly Broederdorf enrolled in Medicare?

Yes. Kelly Broederdorf 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.

Is Kelly Broederdorf affiliated with any hospitals?

According to CMS data, Kelly Broederdorf is affiliated with Northwestern Medicine Mchenry, Northwestern Lake Forest Hospital and Northwestern Medicine Central Dupage Hospital.

When was this NPI record last updated?

The NPPES record for Kelly Broederdorf was last updated on June 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.