Individual provider Active NPI

Richard Todd Kerr, PA-C, ATC

  • Physician Assistant
  • Peoria, IL
National Provider Identifier
1881662385
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004215 Issued in IL
Practice address
303 N William Kumpf Blvd
Peoria, IL 61605-2507
Phone
(309) 676-5546
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085004215 IL Primary

Addresses

Primary practice location

303 N William Kumpf Blvd
Peoria, IL 61605-2507

Mailing address

303 N William Kumpf Blvd
Peoria, IL 61605-2507
Phone (309) 676-5546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120516000423 IL Practitioner - Physician Assistant 5395908008 Reassigns benefits to 1 organization
I20170517001393 MI Practitioner - Physician Assistant 5395908008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
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)

7800 N Sommer St
Peoria, IL 61615-1934
Phone (309) 676-5546

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085004215ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Mecosta County Medical Center Physician Assistant CurrentSince Jun 11, 2017 Accepting new patients
Mecosta County Medical Center CurrentSince Jun 11, 2017 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 17, 2016 Accepting new patients

Locations

8800 State Route 91
Peoria, IL 61615
Phone (309) 683-5000

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

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

303 N William Kumpf Blvd
Peoria, IL 61605
Phone (309) 676-5546

605 Oak St
Big Rapids, MI 49307
Phone (231) 592-1079

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

300 N Patterson Rd
Reed City, MI 49677
Phone (231) 832-3271

Organizations & group practices 5

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": "1322697600000",
    "number": "1881662385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N WILLIAM KUMPF BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052507",
            "telephone_number": "309-676-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N WILLIAM KUMPF BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052507",
            "telephone_number": "309-676-5546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERR",
        "first_name": "RICHARD",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.