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Individual provider Active NPI

Kallista Kamberos, DO

  • Family Medicine Physician
  • Ottawa, IL
National Provider Identifier
1932776101
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036167538 Issued in IL
Practice address
1614 E Norris Dr
Ottawa, IL 61350-3681
Phone
(815) 433-1010
Fax
(815) 433-0067
NPI assigned
Jun 7, 2021
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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 036167538 IL Primary

Addresses

Primary practice location

1614 E Norris Dr
Ottawa, IL 61350-3681

Mailing address

1614 E Norris Dr
Ottawa, IL 61350-3681
Phone (815) 433-1010

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
I20240725002235 IL Practitioner - Family Practice 6608279237 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Carolinas Campus, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint James HospitalGroup PAC ID 0648187252, 74 clinicians

Practice addresses (Care Compare)

111 Spring St
FL 4
Streator, IL 61364-3332
Phone (815) 672-4587

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036167538ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Jul 15, 2024 Accepting new patients
Ottawa Regional Hospital & Healthcare Center CurrentSince Jul 15, 2024 Accepting new patients
Ottawa Regional Hospital & Healthcare Center Family Medicine CurrentSince Jul 15, 2024 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital CurrentSince Jul 15, 2024 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 15, 2024 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Ottawa Regional Hospital & Healthcare Center Past Accepting new patients

Locations

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

1614 E Norris Dr
Ottawa, IL 61350
Phone (815) 433-1010

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

111 Spring St
Streator, IL 61364
Phone (815) 672-4587

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1932776101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503681",
            "telephone_number": "815-433-1010",
            "fax_number": "815-433-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMBEROS",
        "first_name": "KALLISTA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-07",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036167538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

Verify at the official NPI Registry.