ERIC A KIVISTO (NPI# 1447257316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447257316 |
| Entity Type | Individual |
| Full Name | ERIC A KIVISTO |
| Credential | DO |
| Practice Address |
1405 E 12th St Suite 500 Mendota IL 61342-9010 |
| Mailing Address |
1401 E 12th St Mendota IL 61342-9216 |
| Practice Telephone | 8155391789 |
| Practice Fax Number | 8155391430 |
| Mailing Telephone | 8155391789 |
| Mailing Fax Number | 8155391430 |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2014-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 5101011210 | MI | Allopathic & Osteopathic Physicians |
| Y | 208600000X | Surgery | 036091073 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS/BLUE SHIELD | 02706617 | 01 |
| IL | FEIN NUMBER | 371342699 | 01 |
| IL | 036091073 | 05 |
| Street Address |
1405 E 12TH ST SUITE 500 |
| City | MENDOTA |
| State | IL |
| Zip Code | 61342-9010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952897001 | Diana M Olsen | Nurse Practitioner | 1405 E 12th St, Mendota, IL 61342-9010 | 2018-07-02 |
| 1508319914 | Stacy A Piller | Registered Nurse | 1405 E 12th St, Ste 600, Mendota, IL 61342-9010 | 2016-08-02 |
| 1790140580 | Caitlin J Engels-arteaga | Physician Assistant | 1405 E 12th St, Suite 600, Mendota, IL 61342-9010 | 2015-12-21 |
| 1306216098 | Joy Preciado | Nurse Practitioner | 1405 E 12th St, Ste 300, Mendota, IL 61342-9010 | 2015-10-07 |
| 1316320849 | Mendota Community Hospital | Clinic/Center | 1405 E 12th St, Mendota, IL 61342-9010 | 2015-07-01 |
| 1164820312 | Jonathan Edwards | Nurse Practitioner | 1405 E 12th St, Suite 600, Mendota, IL 61342-9010 | 2014-12-19 |
| 1265562151 | Associated Physicians, Sc | Family Medicine | 1405 E 12th St, Suite 300, Mendota, IL 61342-9011 | 2007-03-07 |
| 1366500852 | Michael P Vercimak | Surgery | 1405 E 12th St, Suite 200, Mendota, IL 61342-1495 | 2006-12-05 |
| 1801982327 | Rebecca C Salvani | Obstetrics & Gynecology | 1405 E 12th St, Suite 200, Mendota, IL 61342-9010 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568536845 | Keri Sundberg | Dentist | 709 Plaza Drive, Mendota, IL 61342 | 2006-11-20 |
| 1114022589 | Goslin Drug Store Inc | Pharmacy | 1212 13th Ave, Mendota, IL 61342 | 2006-09-13 |
| 1467402412 | Neungja Chung | Acupuncturist | Mendota Community Hospital, 1315 Memorial Drive, Mendota, IL 61342 | 2006-05-11 |
| 1487622205 | Kelly R. Minihane | Physician Assistant | 1404 Washington Street, Mendota, IL 61342 | 2006-03-08 |
| 1134193022 | Donald Wilbert Piller | Chiropractor | 1312 Lakewood Dr, Mendota, IL 61342 | 2006-02-15 |
| 1770975377 | National Pain Clinic, LLC | Anesthesiology | 1401 E 12th St, Mendota, IL 61342 | 2015-02-19 |
| 1073869475 | Katherine Rose Riva-foster | Anesthesiology | 1401 E 12th St, Mendota, IL 61342 | 2012-08-03 |
| 1386789220 | Juli Renee Barrett Leifheit | Chiropractor | 901 Main St, Ste A, Mendota, IL 61342 | 2007-02-20 |
| 1205383197 | Mendota Community Hospital | Clinic/Center | 1401 Washington Street, Mendota, IL 61342-0001 | 2016-09-08 |
| 1780699447 | Linnea L Person | Chiropractor | 1301 14th Ave, Mendota, IL 61342-1001 | 2006-07-30 |
| Find all providers in zip 61342 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629245527 | Michael P. Vercimak Mdsc | Surgery | 1311 Memorial Dr, Suite 700, Mendota, IL 61342-1495 | 2008-05-11 |
| 1366500852 | Michael P Vercimak | Surgery | 1405 E 12th St, Suite 200, Mendota, IL 61342-1495 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430166 | Conlan Joseph Pierce | Surgery | 601 W Park St, Urbana, IL 61801 | 2020-06-04 |
| 1376167809 | Francesco Bajani | Surgery | 664 N Dearborn St Apt 2f, Chicago, IL 60654-3848 | 2020-06-01 |
| 1972123099 | Andrea Liu | Surgery | 5841 S Maryland Ave Mc6040, Chicago, IL 60637-1443 | 2020-04-18 |
| 1750917183 | Alberto Maria Fratti | Surgery | 901 S Ashland Ave Apt 711, Chicago, IL 60607-4088 | 2020-03-17 |
| 1841845047 | Barijuve Surgical LLC | Surgery | 380 E Northwest Hwy Ste 200, Des Plaines, IL 60016-2274 | 2019-08-05 |
| 1164081782 | Sean Park | Surgery | 1739 Tudor Ln Unit 308, Northbrook, IL 60062-3778 | 2019-06-07 |
| 1376014175 | Edwardsville Physicians Group LLC | Surgery | 441 South State Route 157 Suite 102, Edwardsville, IL 62025-4012 | 2018-12-06 |
| 1316421324 | Erica Lester | Surgery | John H Stroger, 1969 Ogden Ave, Chicago, IL 60612 | 2018-09-17 |
| 1023513389 | Crystal Siyu Zhang | Surgery | 2160 S 1st Ave Bldg 3210, Maywood, IL 60153 | 2018-03-28 |
| 1376047381 | Richard Lawrence Nelson | Surgery | 1603 W. Taylor St., Room 983, Chicago, IL 60612-4394 | 2018-03-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.