Kenneth A Schaidle, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008408 Issued in IL

Practice address

4620 N University St
Peoria, IL 61614-5889

Phone

(309) 692-8222

Fax

(309) 692-8226

NPI assigned

Sep 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

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

• J a K Enterprises Inc

  • Durable Medical Equipment & Medical Supplies
  • Peoria, IL
  • NPI 1134173321

  O20100930036879

  Same enrollment

Specialty

Optometry

Education

Indiana University - School of Optometry, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J a K Enterprises IncGroup PAC ID 3173519014, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• J a K Enterprises Inc

  • Eyewear Supplier
  • Peoria, IL
  • NPI 1508856923

  Optometrist

  Medicare reassignment Care Compare group NPD
• J a K Enterprises Inc

  • Durable Medical Equipment & Medical Supplies
  • Litchfield, IL
  • NPI 1205663499

  Optometrist

  NPD

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1639166226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8309 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152170",
            "telephone_number": "309-693-9540",
            "fax_number": "309-693-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145889",
            "telephone_number": "309-692-8222",
            "fax_number": "309-692-8226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAIDLE",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008408",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410033418",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7215175",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy J Schaefer, M.D.
• Isaac Schafer, PA
• Luke James Schaffer, DO
• Tiffany L Schaffer, PT
• Tina M. Schaffer, ANP
• Ana Cristina Schallhorn, RD LDN CLC
• Sabrina Schell
• Steven K Schell, MD
• Paul J Schellenberg, LCPC
• Bruce A Schellhammer, PT

• Optometrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.