Eric A Kivisto, DO is a medicare enrolled "Surgery" physician in Mendota, Illinois. He went to Chicago College Of Osteopathy and graduated in 1989 and has 35 years of diverse experience with area of expertise as General Surgery. He is a member of the group practice Crittenden Community Hospital Llc and his current practice location is
1405 E 12th St, Suite 500, Mendota, Illinois. You can reach out to his office (for appointments etc.) via phone at
(815) 539-1789.
Eric A Kivisto is licensed to practice in Illinois (license number 036091073) 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 1447257316.
Physician's Profile
| Full Name | Eric A Kivisto |
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| Gender | Male |
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| Speciality | General Surgery |
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| Experience | 35 Years |
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| Location | 1405 E 12th St, Mendota, Illinois |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Eric A Kivisto attended and graduated from Chicago College Of Osteopathy in 1989
NPI Data:
- NPI Number: 1447257316
- Provider Enumeration Date: 07/06/2005
- Last Update Date: 12/07/2022
Medicare PECOS Information:
- PECOS PAC ID: 8820155963
- Enrollment ID: I20231024000358
Medical Identifiers
Medical identifiers for Eric A Kivisto such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1447257316 | NPI | - | NPPES |
| 371342699 | Other | IL | FEIN NUMBER |
| 036091073 | Medicaid | IL | |
| 02706617 | Other | IL | BLUE CROSS/BLUE SHIELD |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208600000X | Surgery | 5101011210 (Michigan) | Secondary |
| 208600000X | Surgery | 036091073 (Illinois) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Crittenden Community Hospital Llc | 8426398793 | 21 |
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. Eric A Kivisto allows following entities to bill medicare on his behalf.
| Entity Name | Crittenden Community Hospital Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275097339
PECOS PAC ID: 8426398793
Enrollment ID: O20190606001972 |
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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. Eric A Kivisto 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 |
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Eric A Kivisto, DO
1401 E 12th St,
Mendota, IL 61342-9216
Ph: (815) 539-1789 | Eric A Kivisto, DO
1405 E 12th St, Suite 500,
Mendota, IL 61342-9010
Ph: (815) 539-1789 |
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