NPIMap

Individual provider Active NPI

Kevin D Oestmann, MD

  • Family Medicine Physician
  • Herrin, IL
National Provider Identifier
1902913908
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036074512 Issued in IL
Practice address
405 Rushing Drive
Herrin, IL 62948
Phone
(618) 993-3300
Fax
(618) 993-0262
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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 036074512 IL Primary

Addresses

Primary practice location

405 Rushing Drive
Herrin, IL 62948

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other identifiers 5

IdentifierTypeStateIssuer
148485OtherHEALTHLINK
033353OtherHEALTH ALLIANCE
080075456OtherRAILROAD MEDICARE
036074512MedicaidIL
10019630OtherBLUE CROSS/BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address koestmann13941@sih.direct-ci.com

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
I20100130000098 IL Practitioner - Family Practice 6507755949 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Logan Primary Care Service Corp.Group PAC ID 8628967064, 33 clinicians

Practice addresses (Care Compare)

405 Rushing Dr
Herrin, IL 62948-3730
Phone (618) 993-3300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82 of 100Reported as group
Quality
55.9
Promoting interoperability
100
Improvement activities
40
Cost
72.01

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036074512ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Nov 1, 2011 Accepting new patients
Logan Primary Care Service Corp. PastSince Jan 1, 2006 Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

405 Rushing Dr
Herrin, IL 62948
Phone (618) 993-3300

Interoperability endpoints

  • Direct secure messaging: koestmann13941@sih.direct-ci.com

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 7

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1902913908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 RUSHING DRIVE",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OESTMANN",
        "first_name": "KEVIN",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036074512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "148485",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "033353",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080075456",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036074512",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "10019630",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "koestmann13941@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 Rushing Drive",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Herrin, IL

Sources for this page

Verify at the official NPI Registry.