Active NPI
Robert S Kinsella, D.O.
- Obstetrics & Gynecology Physician
- Peru, IL
National Provider Identifier
1417911900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 036-092375
- Practice address
- 1631 4TH St
Peru, IL 61354-3507 - Phone
- (815) 220-8460
- Fax
- (815) 220-8462
- NPI assigned
- Apr 13, 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 036-092375 | IL | Primary |
Addresses
Primary practice location
1631 4TH St
Peru, IL 61354-3507
Mailing address
PO Box 2
Peru, IL 61354-0002
Phone (815) 220-8460
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05032051 | Other | IL | BLUE CROSS BLUE SHIELD IL |
| 036092375 | Medicaid | IL |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-092375 | IL | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468108800000",
"number": "1417911900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2",
"city": "PERU",
"state": "IL",
"postal_code": "613540002",
"telephone_number": "815-220-8460",
"fax_number": "815-220-8462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1631 4TH ST",
"city": "PERU",
"state": "IL",
"postal_code": "613543507",
"telephone_number": "815-220-8460",
"fax_number": "815-220-8462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINSELLA",
"first_name": "ROBERT",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2016-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "IL",
"license": "036-092375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD IL",
"identifier": "05032051",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036092375",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.