Fredric C. Kullberg, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

036 062004 Issued in IL

Practice address

535 Roxbury Rd
Suite B600
Rockford, IL 61107-5076

Phone

(815) 397-7212

Fax

(815) 397-2539

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462320000000",
    "number": "1912010273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 ROXBURY RD",
            "address_2": "SUITE B600",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075076",
            "telephone_number": "815-397-7212",
            "fax_number": "815-397-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 ROXBURY RD",
            "address_2": "SUITE B600",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075076",
            "telephone_number": "815-397-7212",
            "fax_number": "815-397-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULLBERG",
        "first_name": "FREDRIC",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2016-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036 062004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "101 00574",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036 062004",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "290000247",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chadwick Kuehne
• Jolynn C Kuhl, PT
• Kayla Kuhn
• Apeksha Kukadia
• Paul James Kulick, ATC
• Sarthak Kulshreshtha, M.D.
• Michael A Kuna, M.D.
• Patricia A Kunz, LCSW
• Dennis O Kurz, LCSW
• Devan Grace Kuss, OTR

• Pulmonary Disease Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Pulmonary Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.