Kevin John Kellerman, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-025862 Issued in IL

Practice address

16 Junction Dr W
Suite 101
Glen Carbon, IL 62034-2996

Phone

(618) 228-3100

Fax

(618) 288-3434

NPI assigned

Aug 1, 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 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kellerman Dental

  • Dentist
  • Glen Carbon, IL
  • NPI 1215102579
  NPD (past) Authorized official
• Kellerman Dental Group, PC

  • Customized Equipment (DME)
  • Glen Carbon, IL
  • NPI 1538543582
  NPD (past) Authorized official

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1962419317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 JUNCTION DR W",
            "address_2": "SUITE 101",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342996",
            "telephone_number": "618-228-3100",
            "fax_number": "618-288-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 JUNCTION DR W",
            "address_2": "SUITE 101",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342996",
            "telephone_number": "618-228-3100",
            "fax_number": "618-288-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERMAN",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-025862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108441",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karvinen Counseling Services, PC
• Tracy Karvinen, MA, LPC, LCPC, CADC
• Linda Joan Kelleher, CNM
• Kellerman Dental
• Kellerman Dental Group, PC
• Seth Kelly, RPH
• Kyle Minor Kinder
• Angela Eleni Kioultzopoulos, M.S., CCC-SLP
• Sarah Anne Kirkbride, MS
• Kirby L Klostermann, FNP

• General Practice Dentistry in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; 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.