NPIMap

Individual provider Active NPI

Ketan Patel, MD

  • Internal Medicine Physician
  • Princeton, IL
National Provider Identifier
1114910528
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036083069 Issued in IL
Practice address
530 Park Ave E
Ste 101
Princeton, IL 61356-3901
Phone
(815) 872-1221
Fax
(815) 872-2304
NPI assigned
Aug 31, 2005
Last updated
Oct 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036083069 IL Primary

Addresses

Primary practice location

530 Park Ave E
Ste 101
Princeton, IL 61356-3901

Mailing address

530 Park Ave E
Ste 101
Princeton, IL 61356-3901
Phone (815) 872-1221

Other practice location 1

530 Park Ave E
Princeton, IL 61356
Phone (815) 875-2811

Other identifiers 1

IdentifierTypeStateIssuer
036083069MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ketan.patel@perry.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040126000068 IL Practitioner - Internal Medicine 4082525696 Reassigns benefits to 2 organizations
Practice locations: Princeton, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians
Osf Healthcare SystemGroup PAC ID 4284541806, 94 clinicians

Practice addresses (Care Compare)

530 Park Ave E
Princeton, IL 61356-3901

535 Park Ave E
Princeton, IL 61356-2537
Phone (815) 875-4531

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System CurrentSince Jul 1, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Healthcare System CurrentSince Jul 1, 2021 Accepting new patients
Osf Healthcare System Current Accepting new patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Nov 6, 2021 Accepting new patients
Ketan R Patel Internal Medicine PastSince Jul 31, 1991 Accepting new patients
Princeton Emergency Services, LLC Past Accepting new patients
Osf Healthcare System Past Accepting new patients

Locations

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

530 Park Ave E
Princeton, IL 61356
Phone (815) 875-2811

530 Park Ave E
Ste 101
Princeton, IL 61356
Phone (815) 872-1221

600 E 1st St
Spring Valley, IL 61362
Phone (815) 664-1477

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1114910528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "address_2": "STE 101",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-872-1221",
            "fax_number": "815-872-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 PARK AVE E",
            "address_2": "STE 101",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613563901",
            "telephone_number": "815-872-1221",
            "fax_number": "815-872-2304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 Park Ave E",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IL",
            "postal_code": "61356",
            "country_code": "US",
            "telephone_number": "815-875-2811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KETAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036083069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083069",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ketan.patel@perry.cernerdirect.com",
            "affiliation": "N",
            "address_1": "530 Park Ave E",
            "city": "Princeton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Princeton, IL

Sources for this page

Verify at the official NPI Registry.