NPIMap

Individual provider Active NPI

Michael Scott Klein, M.D.

  • Family Medicine Physician
  • Alton, IL
National Provider Identifier
1790834737
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36-117409 Issued in IL
Practice address
2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Phone
(618) 462-2222
Fax
(618) 463-5004
NPI assigned
Jan 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36-117409 IL
Family Medicine Physician 207Q00000X 36-117409 IL Primary

Addresses

Primary practice location

2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569

Mailing address

2 Saint Anthonys Way
Suite 205
Alton, IL 62002-4569
Phone (618) 462-2222

Other identifiers 1

IdentifierTypeStateIssuer
36-117409OtherILLICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070720000704 IL Practitioner - Family Practice 6608977657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2 Saint Anthonys Way
Suite 300
Alton, IL 62002-4581
Phone (618) 462-2226

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36-117409ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients

Locations

2 Saint Anthonys Way
Ste 205
Alton, IL 62002
Phone (618) 462-2222

2 Saint Anthonys Way
Ste 300
Alton, IL 62002
Phone (618) 462-2226

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

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1790834737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SAINT ANTHONYS WAY",
            "address_2": "SUITE 205",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024569",
            "telephone_number": "618-462-2222",
            "fax_number": "618-462-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SAINT ANTHONYS WAY",
            "address_2": "SUITE 205",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024569",
            "telephone_number": "618-462-2222",
            "fax_number": "618-463-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36-117409",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36-117409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "36-117409",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.