Active NPI
Bryan J Kemker, M.D.
- Otolaryngology Physician
- Sterling, IL
National Provider Identifier
1366439390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 036092108
- Practice address
- 101 E Miller Rd
Sterling, IL 61081 - Phone
- (815) 625-4790
- NPI assigned
- Oct 4, 2005
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 036092108 | IL | Primary |
Addresses
Primary practice location
101 E Miller Rd
Sterling, IL 61081
Mailing address
1860 Paysphere Cir
Chicago, IL 60674-0018
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-092108 | Medicaid | IL | |
| P00654906 | Other | IL | RR MEDICARE |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080422000930 | IL | Practitioner - Otolaryngology | 1557449139 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036092108 | IL | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CGH Medical Center | Current | Accepting new patients | |
| CGH Medical Center | Current | Accepting new patients | |
| CGH Medical Center | Current | Accepting new patients | |
| Roman J. Dykun, MD | Otolaryngology | Past | Accepting new patients |
| Dr. Stuart a. Morgenstein & Associates, LTD. | Otolaryngology | Past | Accepting new patients |
| Affiliated Ear, Nose and Throat Physicians | Otolaryngology | Past | Accepting new patients |
Locations
101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285
Organizations & group practices 6
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.
-
- Durable Medical Equipment & Medical Supplies
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- NPI 1447415724
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- Family Medicine Physician
- Sterling, IL
- NPI 1548540636
-
- Otolaryngology Physician
- Ingleside, IL
- NPI 1619012010
Otolaryngology
-
- Otolaryngology Physician
- Carol Stream, IL
- NPI 1992828552
Otolaryngology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1366439390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 PAYSPHERE CIR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606740018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E MILLER RD",
"city": "STERLING",
"state": "IL",
"postal_code": "61081",
"telephone_number": "815-625-4790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEMKER",
"first_name": "BRYAN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-04",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036092108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-092108",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00654906",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sterling, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.