Kelvin Earl Wynn, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34210 Issued in NC

Practice address

815 Main St Ste a
Peoria, IL 61602-1080

Phone

(309) 672-4977

NPI assigned

Sep 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

Howard University College of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Methodist Medical Center of IllinoisGroup PAC ID 1355259714, 387 clinicians

Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment Care Compare group NPD
• Chestnut Health Systems Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bloomington, IL
  • NPI 1366431686
  Medicare reassignment
• Chestnut Health Systems Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wood River, IL
  • NPI 1235941311
  NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD
• Chestnut Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Bloomington, IL
  • NPI 1790055952
  NPD (past)

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

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1104928639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 MAIN ST STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021080",
            "telephone_number": "309-672-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 MAIN ST STE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021080",
            "telephone_number": "309-672-4977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2148 Vadalabene Dr",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620625632",
            "country_code": "US",
            "telephone_number": "618-877-4420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNN",
        "first_name": "KELVIN",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "34210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036117956",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick L Wyffels, M.D.
• Wyman Sicher Eye Associates SC
• Wyman Sicher Eye Associates SC
• Katherine D Wyman, AUDIOLOGIST
• Thomas M Wyman, M.D.
• Robert M. Wynn, DMD
• Luke Yang Xie, MD
• Ruidi Xu
• Manajyoti Yadav, M.D.
• Donald Luheng Yang, MD

• Family Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.