Kaitlin McClenahan Campbell, M.D.
Individual provider Active NPI Family Medicine Physician · Shiloh, IL
NPI 1376989186 · NPPES record last updated May 16, 2023
Key facts
- NPI
- 1376989186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036149656 (IL)
- Practice address
- 1414 Cross St Ste 210
Shiloh, IL 62269-2988 - Phone
- (618) 767-7000
- NPI assigned
- May 20, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Saint Louis University School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fairview Heights Medical Group SC
Practice addresses (Care Compare)
1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240
1404 Cross St
Shiloh, IL 62269-2988
Phone (618) 607-3055
1418 Cross St
Suite 350
Shiloh, IL 62269-2988
Phone (618) 607-3900
Hospital & facility affiliations
- Memorial Hospital
- Barnes Jewish Hospital
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 |
|---|---|---|---|---|
| I20190809001071 | IL | Practitioner - Family Practice |
5890062111 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Heights Medical Group SC | Current |
Accepting new patients | |
| Fairview Heights Medical Group SC | Current | Accepting new patients |
Locations
1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240
1414 Cross St
Ste 230
Shiloh, IL 62269
Phone (618) 607-1260
1414 Cross St
Ste 210
Shiloh, IL 62269
Phone (618) 607-1260
660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433
Interoperability endpoints
- kcampbell1024036@direct.carenet.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 036149656 | IL | |
| Family Medicine Physician | 207Q00000X | TL.0006075 | CO | |
| Family Medicine Physician | 207Q00000X | 036149656 | IL | Yes |
Addresses
Primary practice location
1414 Cross St Ste 210
Shiloh, IL 62269-2988
Mailing address
1414 Cross St Ste 210
Shiloh, IL 62269-2988
Phone (618) 767-7000
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Shiloh, IL
- Ariana Brown
- Mary Brunhaver
- Misty Germaine Burns
- Ca Group, LLC
- Antinia Cage
- Chazz N Carr
- Cep America - Illinois SNF, LLP
- Cep America - Illinois SNF, LLP
- Cep America Illinois LLP
- Cep America-Illinois Hospitalists, LLP
All providers in Shiloh, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 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.