Jamin Kweku Addae, MD
Individual provider Active NPI Surgery Physician · Peoria, IL
NPI 1376906446 · NPPES record last updated Sep 25, 2023
Key facts
- NPI
- 1376906446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 2182 (MD)
- Practice address
- 124 SW Adams St
Peoria, IL 61602-1308 - Phone
- (309) 691-4005
- NPI assigned
- Apr 5, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
Hospital & facility affiliations
- Saint Francis Medical Center
- Osf Saint Elizabeth MDL Ctr
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Mastectomy | 23 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230822000543 | IL | Practitioner - General Surgery | 9537454491 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2182 | MD | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Vanderbilt University Medical Center | Surgery | Past |
Accepting new patients |
Locations
1310 N Missouri Ave
Peoria, IL 61603
Phone (309) 308-3800
8600 State Route 91
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2182 | MD | Yes |
Addresses
Primary practice location
124 SW Adams St
Peoria, IL 61602-1308
Mailing address
124 SW Adams St
Peoria, IL 61602-1308
Phone (309) 691-4005
Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.