Individual provider Active NPI

Kwesi Grant-Acquah, MD

  • Internal Medicine Physician
  • Springfield, IL
National Provider Identifier
1669604468
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125-057253 Issued in IL
Practice address
701 N 1St St
Springfield, IL 62781-0001
Phone
(217) 545-0182
Fax
(217) 545-4735
NPI assigned
Aug 13, 2009
Last updated
Aug 21, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125-057253 IL Primary

Addresses

Primary practice location

701 N 1St St
Springfield, IL 62781-0001

Mailing address

PO Box 19656
Springfield, IL 62794-9656
Phone (217) 545-8853

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20160107002235 WI Practitioner - Internal Medicine 6103079330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

7810 W Good Hope Rd
Milwaukee, WI 53223-4518
Phone (414) 586-9255

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-057253ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Family Medical SC CurrentSince Jan 6, 2016 Accepting new patients
Omni Family Medical SC Internal Medicine CurrentSince Jan 6, 2016 Accepting new patients

Locations

1134 W North Ave
Milwaukee, WI 53205
Phone (414) 374-9575

7810 W Good Hope Rd
Milwaukee, WI 53223
Phone (414) 586-9255

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FIHCAA/Endpoint/FIHCAA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1669604468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19656",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949656",
            "telephone_number": "217-545-8853",
            "fax_number": "217-545-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627810001",
            "telephone_number": "217-545-0182",
            "fax_number": "217-545-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT-ACQUAH",
        "first_name": "KWESI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-13",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125-057253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.