Individual provider Active NPI

Joseph M Welty, M.D.

  • Family Medicine Physician
  • Dixon, IL
National Provider Identifier
1861460586
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-068668 Issued in IL
Practice address
102 S Hennepin Ave
Dixon, IL 61021
Phone
(815) 288-7711
Fax
(815) 285-8924
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-068668 IL Primary

Addresses

Primary practice location

102 S Hennepin Ave
Dixon, IL 61021

Mailing address

102 S Hennepin Ave
Dixon, IL 61021-3083
Phone (815) 288-7711

Other identifiers 1

IdentifierTypeStateIssuer
036068668MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040521000464 IL Practitioner - Family Practice 1759372303 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Chicago, Pritzker School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

102 S Hennepin Ave
Suite 201
Dixon, IL 61021-3013
Phone (815) 288-7711

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-068668ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. CurrentSince Apr 1, 2004 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 17, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
KSB Medical Group, Inc. Family Medicine CurrentSince Apr 1, 2004 Accepting new patients

Locations

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

102 S Hennepin Ave
Dixon, IL 61021
Phone (815) 285-8520

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 4

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 1

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": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1861460586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213083",
            "telephone_number": "815-288-7711",
            "fax_number": "815-285-8924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-288-7711",
            "fax_number": "815-285-8924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELTY",
        "first_name": "JOSEPH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-068668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036068668",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.