| Kenneth Fraser, | |
|
411 Hamilton Blvd, 1824, Peoria, IL 61602-1144 | |
| (309) 494-9320 | |
| Not Available |
| Full Name | Kenneth Fraser |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 43 Years |
| Location | 411 Hamilton Blvd, Peoria, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194826115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 088568 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Saint Francis Medical Center | Peoria, IL | Hospital |
| Ottawa Regional Hospital Dba Osf Saint Elizabeth Mdl Ctr | Ottawa, IL | Hospital |
| St Mary Medical Center | Galesburg, IL | Hospital |
| St Joseph Medical Center | Bloomington, IL | Hospital |
| Osf Sacred Heart Medical Center | Danville, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Central Illinois Radiological Associates Ltd | 9436061827 | 162 |
| Entity Name | Central Illinois Radiological Associates Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538192828 PECOS PAC ID: 9436061827 Enrollment ID: O20031104000332 |
| Entity Name | Osf Multi-specialty Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Fraser, 10335 N Port Washington Rd, Suite 250, Mequon, WI 53092-5763 Ph: () - | Kenneth Fraser, 411 Hamilton Blvd, 1824, Peoria, IL 61602-1144 Ph: (309) 494-9320 |
Dr. Lawrence C Wang, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 401 Sw Water St, 1824, Peoria, IL 61602 Phone: 309-494-9320 | |
Dr. Matthew Trent Carpenter, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 221 Ne Glen Oak Ave, Department Of Radiation Oncology, Peoria, IL 61636 Phone: 309-672-5700 Fax: 309-671-2774 | |
Dr. Cameron Wailynn Taylor, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Robert T Bockel, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 401 Sw Water St, Suite 507, Peoria, IL 61602 Phone: 309-494-9320 | |
Dr. Steven J Ullenius, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Dr. Amanda Catherine Cross, M.D. Radiology Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61603 Phone: 309-655-2000 | |
Dr. Derek Beatty, D.O. Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7768 |