NPIMap

Individual provider Active NPI

Brett L. Keller, D.O.

  • Orthopaedic Surgery Physician
  • Bloomington, IL
National Provider Identifier
1407870876
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
036110898 Issued in IL
Practice address
1505 Eastland Dr
Suite 220
Bloomington, IL 61701-3534
Phone
(309) 662-2278
Fax
(309) 663-2956
NPI assigned
Jul 27, 2006
Last updated
Oct 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 036110898 IL Primary

Addresses

Primary practice location

1505 Eastland Dr
Suite 220
Bloomington, IL 61701-3534

Mailing address

1505 Eastland Dr
Suite 220
Bloomington, IL 61701-3534
Phone (309) 662-2278

Other practice location 1

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4340

Other identifiers 10

IdentifierTypeStateIssuer
0361100898OtherILOSF CARE ADVANTAGE
678434OtherILHEALTHLINK
IL0103OtherILJOHN DEERE HEALTH
036110898OtherILOSF CARE PREFERRED
036110898 1MedicaidIL
1302850001OtherILADMINISTAR FEDERAL
133229700OtherILUS DEPARTMENT OF LABOR
036110898OtherILUNITED HEALTHCARE
P00200415OtherILMEDICARE METRAHEALTH
5715378OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041001000143 IL Practitioner - Orthopedic Surgery 2668441098 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Illinois Orthopedic Surgery II LLC.Group PAC ID 5991705428, 5 clinicians

Practice addresses (Care Compare)

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

1505 Eastland Dr
Suite 220
Bloomington, IL 61701-7906
Phone (309) 662-2278

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement38
Knee replacement62
Lower limb (leg) arthroscopy (minimally invasive joint repair)30
Upper limb (arm) arthroscopy (minimally invasive joint repair)20
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association CurrentSince Nov 23, 2020 Accepting new patients
Gibson Community Hospital Association CurrentSince Nov 23, 2020 Accepting new patients
Central Illinois Orthopedic Surgery II LLC. Orthopaedic Surgery CurrentSince Jan 1, 2007 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 5, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1505 Eastland Dr
Bloomington, IL 61701
Phone (309) 663-2100

1505 Eastland Dr
Ste 220
Bloomington, IL 61701
Phone (309) 585-0370

1701 E College Ave
Bloomington, IL 61704
Phone (309) 664-3000

501A S Towanda Barnes Rd
Ste 2
Bloomington, IL 61705
Phone (309) 612-9002

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Interoperability endpoints

  • Direct secure messaging: brett.keller.p11@direct.gapho.nextgenshare.com
  • Direct secure messaging: brett.keller.p45@direct.gapho.nextgenshare.com
  • Direct secure messaging: brettkellerdo@cios.ssdirect.aprima.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1407870876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 220",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-662-2278",
            "fax_number": "309-663-2956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 220",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-662-2278",
            "fax_number": "309-663-2956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 N Melvin St",
            "address_purpose": "LOCATION",
            "city": "Gibson City",
            "state": "IL",
            "postal_code": "609361477",
            "country_code": "US",
            "telephone_number": "217-784-4340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "BRETT",
        "middle_name": "L.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036110898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSF CARE ADVANTAGE",
            "identifier": "0361100898",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "678434",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "IL0103",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSF CARE PREFERRED",
            "identifier": "036110898",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110898 1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTAR FEDERAL",
            "identifier": "1302850001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "133229700",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "036110898",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE METRAHEALTH",
            "identifier": "P00200415",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5715378",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.