Joshua Bradley Kentosh, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036.142442 Issued in IL

Practice address

4909 N. Glen Park Place
Peoria, IL 61614-4676

Phone

(309) 674-7546

Fax

(309) 691-9286

NPI assigned

Jul 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

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 2

Specialty

Dermatology

Education

Lake Erie College of Osteopathic Medicine, Erie, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Soderstrom Dermatology Center S CGroup PAC ID 2062432651, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkentosh@directaddress.net

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.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670

  IA

  Medicare reassignment Care Compare group NPD
• Soderstrom Dermatology Center S C

  • Ambulatory Surgical Clinic/Center
  • Peoria, IL
  • NPI 1053362343
  NPD
• Robert G German MD PC

  • Dermatology Physician
  • Clinton, IA
  • NPI 1568656999
  NPD (past)

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

• Proctor Community Hospital

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1033116876
  Care Compare affiliation
• Proctor Community Hospital

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1134826894
  Care Compare affiliation

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1902096928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N. GLEN PARK PLACE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 N. GLEN PARK PLACE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546",
            "fax_number": "309-691-9286"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4909 N Glen Park Place Rd",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616144676",
            "country_code": "US",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-2075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENTOSH",
        "first_name": "JOSHUA",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036.142442",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036.142442",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.142442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leandre Kennedy, DPM
• Valerie Gail Kennedy, OTR/L
• Kelly Ann Kennell, M.D.
• Kenneth D. Meiss D.M.D. LTD.
• James Nicholas Kenny Jr., M.D.
• Danielle Marie Keowen, OTR
• Cara Nicole Keplar, LCSW
• Kern Optometric Associates PC
• Dustin Kern
• Richard Charles Kern, O.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.