Individual provider Active NPI

Eliathamby Kuganeswaran, M.D.

  • Gastroenterology Physician
  • Peoria, IL
National Provider Identifier
1073555488
Registry record updated May 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036105345 Issued in IL
Practice address
1001 W Main St
Suite 500a
Peoria, IL 61606-1276
Phone
(309) 672-4980
Fax
(309) 671-2944
NPI assigned
Jun 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036105345 IL Primary

Addresses

Primary practice location

1001 W Main St
Suite 500a
Peoria, IL 61606-1276

Mailing address

PO Box 365
Morton, IL 61550-0365
Phone (309) 672-4980

Other identifiers 9

IdentifierTypeStateIssuer
036105345MedicaidIL
100015542OtherILRAILROAD MEDICARE
071696OtherILHEALTH ALLIANCE
371221637OtherILFEDERAL TAX IDENTIFICATIO
658303OtherILHEALTHLINK
07215152OtherILBLUE CROSS
776530OtherILMEDICARE GROUP NUMBER
7991429OtherILAETNA HEALTH PLANS
IL0117OtherILJOHN DEERE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090213000407 IL Practitioner - GastroenterologyPractitioner - Internal Medicine 2668537234 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, 387 clinicians

Practice addresses (Care Compare)

1001 Main St
Suite 500a
Peoria, IL 61606-2038
Phone (309) 672-4980

221 NE Glen Oak
Peoria, IL 61636-0001
Phone (309) 672-5522

221 NE Glen Oak Ave
Peoria, IL 61636-0001

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

815 Main St
Peoria, IL 61602-1076
Phone (309) 672-4977

815 Main St
Suite a
Peoria, IL 61602-1080
Phone (309) 672-4977

Hospital & facility affiliations

  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
  • Carle Health Pekin Hospital Hospital, Pekin, IL, CCN 140120
  • Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Merit-based Incentive Payment System (MIPS)

Final score
84.21 of 100Reported as group
Quality
67.65
Promoting interoperability
99
Improvement activities
40
Cost
80.55

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy158
Upper gastrointestinal (GI) endoscopy for acid reflux125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Elgin Gastroenterology SC Gastroenterology Current Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients
Pekin Prohealth Inc CurrentSince Mar 21, 2018 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Carle Health Care Incorporated Gastroenterology CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Feb 5, 2024 Accepting new patients
Illinois Gastroenterology Group, LLC Gastroenterology CurrentSince Dec 1, 2020 Accepting new patients
Central Illinois Endoscopy Center, LLC Past Accepting new patients

Locations

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

101 S Major St
Eureka, IL 61530
Phone (309) 268-2172

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

600 S 13th St
#J
Pekin, IL 61554
Phone (309) 353-0607

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

1001 Main St
Ste 500B
Peoria, IL 61606
Phone (309) 495-1144

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

1001 Main St
Ste 500A
Peoria, IL 61606
Phone (309) 672-4980

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

815 Main St
Ste A1
Peoria, IL 61602

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243468800000",
    "number": "1073555488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615500365",
            "telephone_number": "309-672-4980",
            "fax_number": "309-671-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W MAIN ST",
            "address_2": "SUITE 500A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061276",
            "telephone_number": "309-672-4980",
            "fax_number": "309-671-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUGANESWARAN",
        "first_name": "ELIATHAMBY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2009-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036105345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105345",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100015542",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "071696",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX IDENTIFICATIO",
            "identifier": "371221637",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "658303",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "07215152",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "776530",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH PLANS",
            "identifier": "7991429",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL0117",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.