Laurel Kietzman, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036119129 Issued in IL

Practice address

2500 W Reynolds St
Pontiac, IL 61764-9774

Phone

(815) 842-2828

NPI assigned

Aug 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Emergency Medicine

Education

Loyola University of Chicago, Stritch School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Methodist Medical Center of IllinoisGroup PAC ID 1355259714, shared by 8 NPIs, 387 clinicians

Cepamerica Illinois LLPGroup PAC ID 3274793633, 492 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
• Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lkietzman923995@direct.unitypoint.org
• Direct secure messaging: lkietzmanmd395384@carlehiedirect.net

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.

• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment Care Compare group NPD
• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947

  Emergency Medicine

  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Emergency Care Clinic/Center
  • Peoria, IL
  • NPI 1265966048
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• CGH Medical Center

  • General Acute Care Hospital
  • Sterling, IL
  • NPI 1902854623
  Medicare reassignment
• Valley Emergency Care Management, Inc.

  • Emergency Medicine Physician
  • Geneva, IL
  • NPI 1841395092
  Medicare reassignment
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD
• Methodist Medical Center of Illinois

  • Psychiatric Hospital Unit
  • Peoria, IL
  • NPI 1275583155
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

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
• St Marys Hospital - Kankakee LLC

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1467290809
  Care Compare affiliation

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1336331222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649774",
            "telephone_number": "815-842-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649774",
            "telephone_number": "815-842-2828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Irving St",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "60187",
            "country_code": "US",
            "telephone_number": "630-752-5072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIETZMAN",
        "first_name": "LAUREL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036119129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth N Jordan, DO
• Arianne M Kaack, PHARMD
• Katie Kennedy
• Misty Kessinger, BS
• Kimberly K Kidner, D.C.
• Robert W Kinas, LCPC
• John Kincinas, PA
• Kind Living Therapy, LLC
• Kianna R Klendworth, BS
• Matthew Charles Knapp, PT

• Emergency Medicine Physician in Pontiac, IL
• Providers in Pontiac, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.

Verify at the official NPI Registry.