NPIMap

Organization Active NPI

Deatrice L Kellogg MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Swansea, IL
National Provider Identifier
1023058484
Registry record updated Sep 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036097679 Issued in IL
Legal business name
DEATRICE L KELLOGG MD
Practice address
2661 N Illinois St
PMB 309
Swansea, IL 62226-2316
Phone
(618) 257-2029
Fax
(618) 235-5371
NPI assigned
Jun 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deatrice Lumae Kellogg, M.D.NPI 1528007416
Title
Owner
Phone
(618) 257-2029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0300X 036097679 IL Primary

Addresses

Primary practice location

2661 N Illinois St
PMB 309
Swansea, IL 62226-2316

Mailing address

2661 N Illinois St
PMB 309
Swansea, IL 62226-2316
Phone (618) 257-2029

Other identifiers 2

IdentifierTypeStateIssuer
DE5033OtherRR MEDICARE
493905552MedicaidIL

National Provider Directory

National Provider Directory

Locations

2661 N Illinois St
Swansea, IL 62226
Phone (618) 257-2029

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1023058484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2661 N ILLINOIS ST",
            "address_2": "PMB 309",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262316",
            "telephone_number": "618-257-2029",
            "fax_number": "618-235-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2661 N ILLINOIS ST",
            "address_2": "PMB 309",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262316",
            "telephone_number": "618-257-2029",
            "fax_number": "618-235-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEATRICE L KELLOGG MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "DEATRICE",
        "authorized_official_middle_name": "LUMAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-257-2029",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036097679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE5033",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "493905552",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.