Kevin G. Koth, D.O.
Individual provider Active NPI Orthopaedic Surgery Physician · Highland, IL
NPI 1972798049 · NPPES record last updated Mar 5, 2026
Key facts
- NPI
- 1972798049
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 036132543 (IL)
- Practice address
- 12866 Troxler Ave
Highland, IL 62249-2806 - Phone
- (618) 900-1070
- Fax
- (833) 992-2437
- NPI assigned
- Sep 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 24
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Ohio University, College of Osteopathic Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Salem Township Hospital
K and L Medical LLC
Select Physical Therapy Holdings Inc
Jersey Community Hospital
Practice addresses (Care Compare)
1201 Ricker Rd
Salem, IL 62881-4263
Phone 61854831948188
12866 Troxler Ave
Highland, IL 62249-2806
Phone (618) 900-1070
326 E Main St
West Frankfort, IL 62896-2402
Phone (618) 937-6200
400 Maple Summit Rd
Jerseyville, IL 62052-2028
Phone (618) 498-6402
Hospital & facility affiliations
- Jersey Community Hospital
- SSM Health St Mary'S Hospital -Centralia
- HSHS St Elizabeth'S Hospital
- St Josephs Hospital
- Salem Township Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Knee replacement | 12 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 11 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130813000526 | IL | Practitioner - Orthopedic Surgery | 8123274917 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02003992A | IN | MD | Orthopaedic Surgery Physician |
| 03476 | KY | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HSHS Medical Group Inc | Current | Accepting new patients | |
| Sarah Bush Lincoln Health Center | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Current |
Accepting new patients | |
| HSHS Medical Group Inc | Current |
Accepting new patients | |
| Jersey Community Hospital | Current | Accepting new patients | |
| Sarah Bush Lincoln Health Center | Current |
Accepting new patients | |
| Jersey Community Hospital | Current |
Accepting new patients | |
| K and L Medical, LLC | Orthopaedic Surgery | Current |
Accepting new patients |
| Jersey Community Hospital District | Current |
Accepting new patients | |
| Jersey Community Hospital | Past | Accepting new patients | |
| Salem Township Hospital | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
9515 Holy Cross Ln
Ste 2
Breese, IL 62230
Phone (217) 347-3003
400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221
1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889
12866 Troxler Ave
Highland, IL 62249
Phone (618) 651-2600
400 Maple Summit Rd
Jerseyville, IL 62052
Phone (618) 498-6402
400 Maple Summit Rd
Ste 200
Jerseyville, IL 62052
Phone (618) 498-3612
1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600
1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100
670 Pierce Blvd
O Fallon, IL 62269
Phone (618) 206-2070
9515 Holy Cross Ln
Saint Rose, IL 62230
Phone (618) 526-4511
1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194
3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321
650 W Taylor St
Vandalia, IL 62471
Phone (618) 283-1231
Interoperability endpoints
- kkoth143@yourcarecommunity.org
- kevin.koth.1@22727.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 02003992A | IN | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | 03476 | KY | |
| Orthopaedic Surgery Physician | 207X00000X | 03476 | KY | |
| Orthopaedic Surgery Physician | 207X00000X | 036132543 | IL | Yes |
Addresses
Primary practice location
12866 Troxler Ave
Highland, IL 62249-2806
Mailing address
PO Box 160
Troy, IL 62294-0160
Phone (618) 900-1070
Other practice location 1
650 W Taylor St
Vandalia, IL 62471-1227
Phone (618) 283-5531
Other practice location 2
400 Maple Summit Rd
Jerseyville, IL 62052-2028
Phone (186) 498-8472
Other practice location 3
9515 Holy Cross Ln Ste 2
Breese, IL 62230-3618
Phone (618) 900-1070
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201114320A | Medicaid | IN | |
| 036-132543 | Medicaid | IL | |
| 000000777934 | Other | KY | ANTHEM |
| 7100213750 | Medicaid | KY |
Other providers in Highland, IL
- Brian Klostermann
- Erica Sue Kniepkamp
- Mallory Korte
- Renae Joan Korte
- Eric Bernard Kosel
- Rebecca Kroiss
- Mark Alan Lacich
- Mary Kirsch Lampe
- Holly Ann Lancaster
- Joseph Francis Laporta
All providers in Highland, IL · Orthopaedic Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.