Kimberli J Guelde, M.D.
Individual provider Active NPI Family Medicine Physician · Polo, IL
NPI 1497726707 · NPPES record last updated Feb 1, 2023
Key facts
- NPI
- 1497726707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036-108558 (IL)
- Practice address
- 1107 S Division Ave
KSB Medical Group
Polo, IL 61064-1875 - Phone
- (815) 946-3453
- Fax
- (815) 946-3908
- NPI assigned
- Jan 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Rowan University School of Osteopathic Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
2200 Fort Jesse Rd
Suite 110
Normal, IL 61761-6286
Phone (309) 661-6290
Hospital & facility affiliations
- Osf Home Health-Eastern Region
- St Joseph Medical Center
- Saint James Hospital
- Carle Bromenn Medical Center
- Saint Anthony Medical Center
- Osf Saint Paul Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
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 |
|---|---|---|---|---|
| I20110104000810 | IL | Practitioner - Family Practice | 9133318363 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-108558 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| KSB Medical Group, Inc. | Family Medicine | Past | Accepting new patients |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477
215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900
2200 Fort Jesse Rd
Ste 110
Normal, IL 61761
Phone (309) 661-6250
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
1107 S Division Ave
Polo, IL 61064
Phone (815) 946-3453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-108558 | IL | Yes |
Addresses
Primary practice location
1107 S Division Ave
KSB Medical Group
Polo, IL 61064-1875
Mailing address
1107 S Division Ave
KSB Medical Group
Polo, IL 61064-1875
Phone (815) 946-3453
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036108558 | Medicaid | IL |
Other names
- Dr. Kimberli J Hileman
Other providers in Polo, IL
- Debra C Drengenberg
- Angelia Faller
- Felker Pharmacy Inc
- Theresa Lynn Fitzgerald
- Carrie C Grobe
- Mid Americacare Foundation
- Karina Nehrkorn
- Henry Oh
- Polo Chiropractic Center PC
- Polo Community Ambulance Service
All providers in Polo, 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 Feb 1, 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.