NPIMap

Organization Active NPI

Central Illinois Orthopedic Surgery II LLC.

  • Orthopaedic Surgery Physician
  • Bloomington, IL
National Provider Identifier
1508889965
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
CENTRAL ILLINOIS ORTHOPEDIC SURGERY II LLC.
Practice address
1505 Eastland Dr
Suite 220
Bloomington, IL 61701-3534
Phone
(309) 662-2278
Fax
(309) 663-2956
NPI assigned
Jul 26, 2006
Organization subpart
No

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

Authorized official

Name
Brett L Keller, D.O.NPI 1407870876
Title
Owner
Phone
(309) 662-2278

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 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 identifiers 3

IdentifierTypeStateIssuer
791203417OtherILMEDICARE METRAHEALTH
IL0101OtherILJOHN DEERE
571537801OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070108000384 IL Part B Supplier - Clinic/Group Practice 5991705428 Receives reassigned benefits from 6 practitioners
Practice locations: Bloomington, IL; Normal, IL

National Provider Directory

National Provider Directory

Locations

808 S Eldorado Rd
Ste 2W
Bloomington, IL 61704
Phone (309) 661-0232

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1508889965",
    "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": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS ORTHOPEDIC SURGERY II LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-662-2278",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE METRAHEALTH",
            "identifier": "791203417",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL0101",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "571537801",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.