Active NPI
Antoni J Kos, MD
- Surgery Physician
- Herrin, IL
National Provider Identifier
1548205222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036109286
- Practice address
- 3307 Logan Dr Ste B
Herrin, IL 62948-3732 - Phone
- (618) 997-3461
- Fax
- (618) 993-6042
- NPI assigned
- Jun 18, 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036109286 | IL | Primary |
Addresses
Primary practice location
3307 Logan Dr Ste B
Herrin, IL 62948-3732
Mailing address
PO Box 1105
Indianapolis, IN 46206-1105
Phone (618) 997-3461
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036109286 | Medicaid | IL | |
| 7210895 | Other | IL | AETNA |
| 3932056 | Other | IL | BCBS OF IL |
| 779555 | Other | IL | HEALTHLINK |
| 130745 | Other | IL | HEALTH ALLIANCE |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036109286 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332374400000",
"number": "1548205222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1105",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462061105",
"telephone_number": "618-997-3461",
"fax_number": "618-993-6042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3307 LOGAN DR STE B",
"city": "HERRIN",
"state": "IL",
"postal_code": "629483732",
"telephone_number": "618-997-3461",
"fax_number": "618-993-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOS",
"first_name": "ANTONI",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-18",
"last_updated": "2012-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036109286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036109286",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7210895",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "3932056",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "779555",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "130745",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.