Kevin M Ponciroli, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036115733 Issued in IL

Practice address

793 Sunset Blvd
O Fallon, IL 62269-1960

Phone

(618) 668-2473

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22493/brand/1/csg/1/fhir/r4
• Direct secure messaging: kevin.ponciroli.1@22493.direct.athenahealth.com

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.

• Redbird Pediatrics, PLLC

  • Pediatrics Physician
  • O'Fallon, IL
  • NPI 1124634449
  NPD Authorized official
• St .Clair Pedaitrics, LLC

  • Pediatrics Physician
  • Swansea, IL
  • NPI 1073705737
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1598776411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 SUNSET BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691960",
            "telephone_number": "618-668-2473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 SUNSET BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691960",
            "telephone_number": "618-668-2473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "914 Red Scarlet Ct",
            "address_purpose": "LOCATION",
            "city": "Shiloh",
            "state": "IL",
            "postal_code": "622218306",
            "country_code": "US",
            "telephone_number": "618-622-4955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONCIROLI",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036115733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115733",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miranda Francis Pogue, FNP-BC
• Sarah Jane Poirot, NP-C
• Amillia Polk, LPN
• Emily Pollman
• Sydney Pollmann, APRN
• Aurelia Popp
• Kimberly Elise Portale, D.O.
• Rece Portell, PA
• Amy Jean Porter, MS, CCC-SLP/L
• Shayla Porter, RBT

• Pediatrics Physician in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.