Active NPI
Kenneth Joseph Prebil, M.D.
- Surgery Physician
- Peoria, AZ
National Provider Identifier
1396707451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 5770
- Practice address
- 14155 N 83Rd Ave Ste A105
Peoria, AZ 85381-5640 - Phone
- (623) 486-7700
- NPI assigned
- Apr 4, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 5770 | AZ | Primary |
Addresses
Primary practice location
14155 N 83Rd Ave Ste A105
Peoria, AZ 85381-5640
Mailing address
14155 N. 83Rd Ave.
Ste. a-105
Peoria, AZ 85381
Phone (623) 486-7700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225319 | Medicaid | AZ | |
| AZ0053950 | Other | AZ | BLUE CROSS BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5770 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1396707451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14155 N. 83RD AVE.",
"address_2": "STE. A-105",
"city": "PEORIA",
"state": "AZ",
"postal_code": "85381",
"telephone_number": "623-486-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14155 N 83RD AVE STE A105",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853815640",
"telephone_number": "623-486-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREBIL",
"first_name": "KENNETH",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "5770",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "225319",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD ID",
"identifier": "AZ0053950",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.