Active NPI
Kevin Chibouzo Ilo, M.D.
- Orthopaedic Surgery Physician
- Williamsville, NY
National Provider Identifier
1366124166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 343150
- Practice address
- 111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182 - Phone
- (716) 204-3200
- Fax
- (716) 204-4337
- NPI assigned
- Aug 2, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 343150 | NY | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182
Mailing address
4225 Genesee St Ste 400
Cheektowaga, NY 14225-1994
Phone (716) 204-3200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- Other, 2011
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1400 SW 5TH Ave
FL 5
Portland, OR 97201-5509
1838 9TH St
Santa Monica, CA 90404-4529
1838 9TH St Apt
Suite 202
Santa Monica, CA 90404-4531
4225 Genesee St
Suite 400
Cheektowaga, NY 14225-1994
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 14 |
| Knee replacement | 24 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SPI829 | CA | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785110400000",
"number": "1366124166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4225 GENESEE ST STE 400",
"city": "CHEEKTOWAGA",
"state": "NY",
"postal_code": "142251994",
"telephone_number": "716-204-3200",
"fax_number": "716-204-4337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N MAPLEMERE RD STE 100",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142213182",
"telephone_number": "716-204-3200",
"fax_number": "716-204-4337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILO",
"first_name": "KEVIN",
"middle_name": "CHIBOUZO",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-02",
"last_updated": "2026-07-27",
"certification_date": "2026-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NY",
"license": "343150",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Williamsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.