Derek G Kenneaster, MD is a medicare enrolled "Dermatology" physician in Herrin, Illinois. He went to Southern Illinois University School Of Medicine and graduated in 1993 and has 31 years of diverse experience with area of expertise as Dermatology. He is a member of the group practice Southern Illinois Dermatology, Pc and his current practice location is
220 N Park Ave, Suite 2, Herrin, Illinois. You can reach out to his office (for appointments etc.) via phone at
(618) 942-3344.
Derek G Kenneaster is licensed to practice in Florida (license number ME94334) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1457372724.
Physician's Profile
| Full Name | Derek G Kenneaster |
|---|
| Gender | Male |
|---|
| Speciality | Dermatology |
|---|
| Experience | 31 Years |
|---|
| Location | 220 N Park Ave, Herrin, 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. |
|---|
Medical Education and Training:
- Derek G Kenneaster attended and graduated from Southern Illinois University School Of Medicine in 1993
NPI Data:
- NPI Number: 1457372724
- Provider Enumeration Date: 07/22/2006
- Last Update Date: 03/23/2011
Medicare PECOS Information:
- PECOS PAC ID: 9133147911
- Enrollment ID: I20101124000877
Medical Identifiers
Medical identifiers for Derek G Kenneaster such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457372724 | NPI | - | NPPES |
| 036093018 | Medicaid | IL | |
| 10007459 | Other | | BCBS |
| 65958 | Other | | MEDICARE PTAN |
| 31057 | Other | FL | BCBS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | ME94334 (Florida) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Southern Illinois Dermatology, Pc | 2769479203 | 13 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek G Kenneaster allows following entities to bill medicare on his behalf.
| Entity Name | Southern Illinois Healthcare Foundation, Inc. |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1013198712
PECOS PAC ID: 1456256874
Enrollment ID: O20031126000641 |
|---|
| Entity Name | Southern Illinois Dermatology, Pc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1306870233
PECOS PAC ID: 2769479203
Enrollment ID: O20040427001593 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek G Kenneaster is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Derek G Kenneaster, MD
220 N Park Ave, Suite 2,
Herrin, IL 62948-3150
Ph: (618) 942-3344 | Derek G Kenneaster, MD
220 N Park Ave, Suite 2,
Herrin, IL 62948-3150
Ph: (618) 942-3344 |
Reviews and Comments