Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Alyssa Brie Ketchum, PA-C

Individual provider Surgical Physician Assistant · NPI 1104200625

Alyssa Brie Ketchum, PA-C is a Physician Assistant in Chicago, Illinois. Qualified in 2015, 11 years ago. Accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
11
Licensed in
IL
In the registry since
2015
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

676 N Saint Clair St Ste 1900
Chicago, IL 60611-2986
Phone: (312) 926-5354
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 085005549 (IL)

Record details

NPI number1104200625
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 14, 2015
Last updated in NPPESDecember 17, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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