Derek G Kenneaster, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME94334 Issued in FL

Practice address

220 N Park Ave
Suite 2
Herrin, IL 62948-3150

Phone

(618) 942-3344

Fax

(618) 942-5045

NPI assigned

Jul 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Southern Illinois University School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Illinois Dermatology, PCGroup PAC ID 2769479203, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Herrin Hospital Hospital, Herrin, IL, CCN 140011
• Harrisburg Medical Center Hospital, Harrisburg, IL, CCN 140210

Merit-based Incentive Payment System (MIPS)

Final score

89.81 of 100Reported as group

Quality

79.62

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Illinois Dermatology, PC

  • Dermatology Physician
  • Herrin, IL
  • NPI 1306870233
  Medicare reassignment Care Compare group NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Harrisburg Medical Center Inc

  • General Acute Care Hospital
  • Harrisburg, IL
  • NPI 1073580130
  Care Compare affiliation
• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300838400000",
    "number": "1457372724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N PARK AVE",
            "address_2": "SUITE 2",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483150",
            "telephone_number": "618-942-3344",
            "fax_number": "618-942-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N PARK AVE",
            "address_2": "SUITE 2",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483150",
            "telephone_number": "618-942-3344",
            "fax_number": "618-942-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEASTER",
        "first_name": "DEREK",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2011-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME94334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093018",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10007459",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "65958",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31057",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody Johnson, LPN
• Jared Jones
• Leslie Suzanne Jones, N.P. - C
• Mary Kalert, PTA
• Cyril Kamya, M.D
• Debra J Kester, PA-C
• Avery Victoria Ketteman, RBT
• Brandi Rose Kirby, OTR/L
• Dena Leigh Kirk, OTR/L
• Katherine Jo Kleckner, RPH

• Dermatology Physician in Herrin, IL
• Providers in Herrin, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.