Active NPI
Keegan Duelfer, DPM
- Foot & Ankle Surgery Podiatrist
- Champaign, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 016006010
- Practice address
- 2300 S 1St St
Champaign, IL 61820-7661 - Phone
- (217) 383-9564
- NPI assigned
- Sep 1, 2018
- Last updated
- Feb 20, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 016006010 | IL | Primary |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | POD-001042 | AZ |
Addresses
Primary practice location
2300 S 1St St
Champaign, IL 61820-7661
Mailing address
611 W Park St
Fapc
Urbana, IL 61801-2500
Other practice location 1
7301 E 2nd St Ste 206
Scottsdale, AZ 85251-5610
Phone (602) 761-7819
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z276117 | Medicaid | AZ |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.phoenixfai.com/ |
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: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2300 S 1St St
Champaign, IL 61820-7661
Phone (217) 383-9400
611 W Park St
Urbana, IL 61801-2500
611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POD-001042 | AZ | MD | Foot & Ankle Surgery Podiatrist |
| 016006010 | IL | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carle Health Medical Group | Current | Accepting new patients | |
| Carle Health Care Incorporated | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
2300 S 1st St
Champaign, IL 61820
Phone (217) 383-9400
611 W Park St
Urbana, IL 61801
Phone (217) 383-6941
Interoperability endpoints
- kduelferdpm377991@carlehiedirect.net
Organizations & group practices 3
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.
-
dba Carle Physician Group
- Internal Medicine Physician
- Urbana, IL
- NPI 1154653947
-
- Durable Medical Equipment & Medical Supplies
- Champaign, IL
- NPI 1114240876
-
dba Gibson Area Hospital and Health Services
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Urbana, IL
- NPI 1013071653
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708387200000",
"number": "1245712678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W PARK ST",
"address_2": "FAPC",
"city": "URBANA",
"state": "IL",
"postal_code": "618012500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 S 1ST ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207661",
"telephone_number": "217-383-9564"
}
],
"practiceLocations": [
{
"address_1": "7301 E 2nd St Ste 206",
"address_purpose": "LOCATION",
"city": "Scottsdale",
"state": "AZ",
"postal_code": "852515610",
"country_code": "US",
"telephone_number": "602-761-7819",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DUELFER",
"first_name": "KEEGAN",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-01",
"last_updated": "2024-02-20",
"certification_date": "2024-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "IL",
"license": "016006010",
"primary": true
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "AZ",
"license": "POD-001042",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Z276117",
"state": "AZ"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.phoenixfai.com/",
"affiliation": "N",
"address_1": "7301 E 2nd St Ste 206",
"city": "Scottsdale",
"state": "AZ",
"country_code": "US",
"postal_code": "852515610",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; 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.