Active NPI
Kyle David Van Bevern, PHARMD
- Pharmacist
- Collinsville, IL
National Provider Identifier
1114630951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051305030
- Practice address
- 1800 Vandalia St
Collinsville, IL 62234-4844 - Phone
- (618) 344-8473
- Fax
- (618) 344-8557
- NPI assigned
- Dec 26, 2022
- Last updated
- Dec 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051305030 | IL | Primary |
Addresses
Primary practice location
1800 Vandalia St
Collinsville, IL 62234-4844
Mailing address
934 Northwestern Ave
Fairview Heights, IL 62208-3798
Phone (618) 975-9726
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | RxConnect | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051305030 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672012800000",
"number": "1114630951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "934 NORTHWESTERN AVE",
"city": "FAIRVIEW HEIGHTS",
"state": "IL",
"postal_code": "622083798",
"telephone_number": "618-975-9726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 VANDALIA ST",
"city": "COLLINSVILLE",
"state": "IL",
"postal_code": "622344844",
"telephone_number": "618-344-8473",
"fax_number": "618-344-8557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BEVERN",
"first_name": "KYLE",
"middle_name": "DAVID",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-26",
"last_updated": "2022-12-26",
"certification_date": "2022-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051305030",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "RxConnect",
"affiliation": "N",
"endpointDescription": "Pharmacy database",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1800 Vandalia St",
"city": "Collinsville",
"state": "IL",
"country_code": "US",
"postal_code": "622344844",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Collinsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.