Individual provider Active NPI

Jeffery P Mendell, MD

  • Diagnostic Radiology Physician
  • Kankakee, IL
National Provider Identifier
1629285556
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036113476 Issued in IL
Practice address
350 N Wall St
Kankakee, IL 60901-2991
Phone
(815) 933-1671
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 036-113476 IL
Diagnostic Radiology Physician 2085R0202X 036113476 IL Primary

Addresses

Primary practice location

350 N Wall St
Kankakee, IL 60901-2991

Mailing address

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

Other identifiers 2

IdentifierTypeStateIssuer
036113476MedicaidIL
4615054OtherILBCBS ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070706000032 IL Practitioner - Diagnostic Radiology 1759481625 Reassigns benefits to 4 organizations
I20260508000214 MO Practitioner - Diagnostic Radiology 1759481625 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Southern Illinois University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1000 W Harlem Ave
Monmouth, IL 61462-1007
Phone (309) 734-1400

1051 W S St
Kewanee, IL 61443-8354
Phone (309) 852-7500

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

111 Spring St
Streator, IL 61364-3332
Phone (815) 673-2311

12701 W 143Rd St
Homer Glen, IL 60491-7715
Phone (708) 364-6337

1401 E 12TH St
Mendota, IL 61342-9216
Phone (815) 539-7461

1505 Eastland Dr
Bloomington, IL 61701-3636
Phone (309) 663-2100

1650 Midtown Rd
Peru, IL 61354-1200
Phone (815) 538-1351

17047 La Grange Rd
Orland Park, IL 60487-7227
Phone (815) 300-7764

1870 Silver Cross Blvd
Suite 150
New Lenox, IL 60451-8648
Phone (815) 300-1063

1900 Silver Cross Blvd
New Lenox, IL 60451-9509
Phone (815) 300-1100

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

2200 Fort Jesse Rd
Suite 100
Normal, IL 61761-6286
Phone (309) 661-6280

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone (309) 672-5522

2406 E Empire St
Bloomington, IL 61704-3630
Phone (309) 664-3161

2406 Empire St
Bloomington, IL 61704-3630
Phone (309) 740-4272

2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828

2800 W 95TH St
Evergreen, IL 60805-2701
Phone (309) 740-4272

3315 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-1000

3333 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-3161

435 Maxine Dr
Morton, IL 61550-2498
Phone (309) 263-2424

500 W Romeo B Garrett Ave
Peoria, IL 61605-2301
Phone (309) 740-4272

5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-2428

5200 Reliable Pkwy
Chicago, IL 60686-0052

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 740-4272

Hospital & facility affiliations

  • Silver Cross Hospital and Medical Centers Hospital, New Lenox, IL, CCN 140213
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Saint James Hospital Hospital, Pontiac, IL, CCN 140161
  • Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110
  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-113476ILMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group CurrentSince Aug 20, 2025 Accepting new patients
Riverside Health System CurrentSince Jan 3, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Central Illinois Radiological Associates, LTD. Diagnostic Radiology CurrentSince Dec 6, 2025 Accepting new patients
Cira Michigan PC Diagnostic Radiology CurrentSince Jan 1, 2026 Accepting new patients
Riverside Health System CurrentSince Jan 3, 2023 Accepting new patients
Kankakee Radiology Associates, S.C. Past Accepting new patients

Locations

300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666

5200 Reliable Pkwy
Chicago, IL 60686
Phone (309) 671-8748

1905 W Court St
Kankakee, IL 60901
Phone (815) 933-2240

401 N Wall St
Ste 205
Kankakee, IL 60901
Phone (815) 932-2541

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

530neglen Oak Ave
Peoria, IL 61636
Phone (309) 685-1054

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

114 W Stratford Dr
Ste E
Peoria, IL 61614
Phone (309) 740-4270

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

111 Oakwood Rd
Peoria, IL 61611
Phone (586) 412-4144

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1629285556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKWOOD RD",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111853",
            "telephone_number": "309-740-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012991",
            "telephone_number": "815-933-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDELL",
        "first_name": "JEFFERY",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036-113476",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036113476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113476",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "4615054",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.