KSB Medical Group, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KSB MEDICAL GROUP, INC.

Doing business as

KSB Center for Diabetes Management

Practice address

215 E 1St St
Ste 101
Dixon, IL 61021-3166

Phone

(815) 285-5973

Fax

(815) 285-5974

NPI assigned

Mar 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kevin T Marx

Title

Vice President

Phone

(815) 285-5508

Specialties & licenses 1

Addresses

Other names 1

• KSB Center for Diabetes Management Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119

  O20040203000860

  Same enrollment
• KSB Medical Group, Inc.

  dba KSB Optical

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1306814603

  O20040203000860

  Same enrollment

Locations

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Abdulhamid H Alkhalaf, M.D.

  • Infectious Disease Physician
  • Dixon, IL
  • NPI 1043237035
  NPD
• Earel M. Belford, MD

  • Emergency Medicine Physician
  • Dixon, IL
  • NPI 1861439010
  NPD
• Tyrone Robert Brand, M.D.

  • Hospitalist Physician
  • Dixon, IL
  • NPI 1285017947
  NPD
• Courtney M Duffy, APRN, CNM

  • Advanced Practice Midwife
  • Sterling, IL
  • NPI 1083189823
  NPD
• James Francis Gallant, MD

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1295712974
  NPD
• Susan Heffelfinger, PH.D

  • Clinical Psychologist
  • Dixon, IL
  • NPI 1871736355
  NPD
• Juan C Hernandez, M.D.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1780650176
  NPD
• Lisa E Hosea, MD

  • Hospitalist Physician
  • Lombard, IL
  • NPI 1871560060
  NPD
• Rajeev Kumar Jain, M.D.

  • Orthopaedic Surgery Physician
  • Sycamore, IL
  • NPI 1437103314
  NPD
• Asad Jamal, M.D.

  • Family Medicine Physician
  • Morrison, IL
  • NPI 1013950476
  NPD
• Joyce Johnson, M.D.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1033464987
  NPD
• William P Long, D.O.

  • Obstetrics & Gynecology Physician
  • Dixon, IL
  • NPI 1568430460
  NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629046115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E 1ST ST",
            "address_2": "STE 101",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213166",
            "telephone_number": "815-285-5973",
            "fax_number": "815-285-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 1ST ST",
            "address_2": "STE 101",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213166",
            "telephone_number": "815-285-5973",
            "fax_number": "815-285-5974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSB MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARX",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "815-285-5508",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KSB Center for Diabetes Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Eileen Kromeke, MA
• Thomas Edward Kruger, DDS
• KSB Medical Group, Inc.
• KSB Medical Group, Inc. (KSB Optical)
• KSB Medical Group, Inc. (KSB Eye & Vision Care)
• Sara E Kunkel
• L. Johnson Chiropractic
• Margaret A Lafever, LCSW
• Angela Todt Landrowski, D.D.S.
• Sandra K Laudon, MS, LCPC, QMHP

• Clinic/Center in Dixon, IL
• Providers in Dixon, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.