Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Gwyneth M Kelleher, PA

Individual provider Medical Physician Assistant · NPI 1578253878

Gwyneth M Kelleher, PA is a Physician Assistant in Chicago, Illinois. Qualified in 2023, 3 years ago. Practices with Baystate Medical Practices Inc, a 1,346-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
3
Licensed in
IL
In the registry since
2023
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1431 N Western Ave Ste 134
Chicago, IL 60622-1797
Phone: (773) 235-1915
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 085011293 (IL)

Record details

NPI number1578253878
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 10, 2023
Last updated in NPPESAugust 7, 2026
Certification dateAugust 7, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Baystate Medical Practices Inc — 1346 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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