Kenneth James Minielly, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

125-068691 Issued in IL

Practice address

751 N Rutledge St Ste 2300
Springfield, IL 62702-4968

Phone

(217) 545-8000

Fax

(217) 545-7438

NPI assigned

Jun 16, 2016

Last updated

Jun 16, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Dermatology

Education

Southern Illinois University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kentucky Skin Cancer Center PLLCGroup PAC ID 2668729336, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Medical Center (Bowling Green) Hospital, Bowling Green, KY, CCN 180013

Merit-based Incentive Payment System (MIPS)

Final score

87.28 of 100Reported as group

Quality

93.33

Promoting interoperability

82

Improvement activities

40

Cost

79.27

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kentucky Skin Cancer Center PLLC

  • MOHS-Micrographic Surgery Physician
  • Bowling Green, KY
  • NPI 1902302987
  Medicare reassignment Care Compare group NPD

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

• Bowling Green-Warren County Community Hospital Corporation

  dba The Medical Center

  • General Acute Care Hospital
  • Bowling Green, KY
  • NPI 1043293608
  Care Compare affiliation

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466035200000",
    "number": "1699125062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19644",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949644",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-7438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST STE 2300",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-7438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINIELLY",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "125-068691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Unser Minderpt, PT
• Mindful Monarch Therapy
• Amanda Rose Miner, RBT
• Michelle M Miner, MD
• Kyle Minert
• Scott A. Mink, M.D.
• Ayisha Minter, NP
• Noupama Nethmini Mirihagalle, MD
• Dureali Mirjat
• Nichole Mirocha, D.O.

• Dermatology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.