NPIMap

Individual provider Active NPI

Kimberly B Whitaker, M.D.

  • Family Medicine Physician
  • Tuscola, IL
National Provider Identifier
1972724979
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036125554 Issued in IL
Practice address
1100 Tuscola Blvd
SBL Tuscola Clinic
Tuscola, IL 61953
Phone
(217) 253-2020
Fax
(217) 253-2023
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5901 AK
Family Medicine Physician 207Q00000X 036125554 IL Primary

Addresses

Primary practice location

1100 Tuscola Blvd
SBL Tuscola Clinic
Tuscola, IL 61953

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4693
Phone (217) 238-6055

Other identifiers 1

IdentifierTypeStateIssuer
036125554MedicaidIL

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
I20101011000416 IL Practitioner - Family Practice 1658413711 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
East Tennessee State University Quillen College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health Center 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644
Phone (217) 258-2525

Hospital & facility affiliations

  • Sarah Bush Lincoln Home Care Home health agency, Charleston, IL, CCN 147594
  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5901AKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Feb 10, 2015 Accepting new patients
Sarah Bush Lincoln Health Center Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

116 W Buchanan Ave
Charleston, IL 61920
Phone (217) 345-7700

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

1100 Tuscola Blvd
Tuscola, IL 61953
Phone (217) 253-2020

Organizations & group practices 12

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 2

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1972724979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384693",
            "telephone_number": "217-238-6055",
            "fax_number": "217-258-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 TUSCOLA BLVD",
            "address_2": "SBL TUSCOLA CLINIC",
            "city": "TUSCOLA",
            "state": "IL",
            "postal_code": "61953",
            "telephone_number": "217-253-2020",
            "fax_number": "217-253-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "KIMBERLY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "5901",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036125554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036125554",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscola, IL

Sources for this page

Verify at the official NPI Registry.