Kwabena A Boateng, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036084514 Issued in IL

Practice address

2321 N Wisconsin Ave
Peoria, IL 61603-5613

Phone

(309) 680-7600

Fax

(309) 681-4681

NPI assigned

Jan 29, 2007

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• K a Boateng MD Facog PC

  • Obstetrics & Gynecology Physician
  • Joliet, IL
  • NPI 1821116468
  NPD (past) Authorized official
• Genesis Health System

  • Anatomic Pathology & Clinical Pathology Physician
  • Davenport, IA
  • NPI 1295196798
  NPD
• Genesis Health System

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945

  Obstetrics & Gynecology

  NPD
• Genesis Health System

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1639215312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 N WISCONSIN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616035613",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-4681"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Glenwood Avenue",
            "address_2": "LLE Lower Level East",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "60435",
            "country_code": "US",
            "telephone_number": "815-553-0500",
            "fax_number": "815-553-0505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOATENG",
        "first_name": "KWABENA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036084514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036084514",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory M. Blume
• William Major Blundell, LCPC
• Monica C Blunier, P.T
• Board of Trustees of the University of Illinois
• Bernard Asirifi Boateng, PHARMD
• Lauren Boaz
• Bochantin Obstetrics & Gynecology Services LTD
• Tracy Ann Bochantin, M.D.
• Robert T Bockel, MD
• Brandon Bockewitz, MD

• Obstetrics & Gynecology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.