DR. SHANE C. FOGO M.D.
NPI 1063446318
Family Medicine in Eureka, IL

Q: What is Shane Fogo's NPI number?

The NPI number for Shane Fogo is 1063446318. It was assigned to this individual provider in the NPPES registry on July 11, 2006.

Q: What is Shane Fogo's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Fogo was last updated on December 14, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 11, 2006PECOS Enrolled

105 S MAJOR ST, EUREKA, IL 61530(309) 467-4691 Get Directions Write a Review

NPPES record last updated: December 14, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Shane C. Fogo M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANE C. FOGO M.D. (NPI 1063446318) is an individual family medicine provider in Eureka, Illinois, licensed in Illinois (036111674) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Proctor Hospital, and is a graduate of University Of Illinois College Of Med (chi/peor/rock/chm-urb) (2002).

NPPES Registry Identity

NPI1063446318

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. SHANE C. FOGOCredential: M.D.

Location Address105 S MAJOR STEureka, IL 61530-1246

Mailing Address701 Lee St, Suite 300Des Plaines, IL 60016-4539 · (847) 390-5900

Phone(309) 467-4691

Sole ProprietorNo

Medical School CMSUniversity Of Illinois College Of Med (chi/peor/rock/chm-urb)Graduated 2002

Enumeration DateJuly 11, 2006

Last NPPES UpdateDecember 14, 2012

✔ NPI 1063446318 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in IL · 036111674

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

105 S MAJOR ST, Eureka, IL 61530

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Other Identifiers 7

Other10215111IL · Bcbs Tch

Other5715395IL · Bcbs Hpt

Medicare ID-Type Unspecified712180IL · Medicare Group Tch

Medicare ID-Type Unspecified748940IL · Medicare Group Hpt

Medicare ID-Type UnspecifiedK28868IL · Medicare Pin Tch

Medicaid036111674IL

Medicare ID-Type UnspecifiedK13837IL · Medicare Pin Hpt

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shane C. Fogo M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2365408606

PECOS Enrollment IDI20041208000245

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Proctor Hospital

Acute Care Hospitals · Peoria, IL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140013

Location5409 N Knoxville AvePeoria, IL 61614 · Peoria County

Emergency services

Saint Francis Medical Center

Acute Care Hospitals · Peoria, IL

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140067

Location530 NE Glen Oak AvePeoria, IL 61637 · Peoria County

Emergency services Birthing friendly

Carle Bromenn Medical Center

Acute Care Hospitals · Normal, IL

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140127

Location1304 Franklin AvenueNormal, IL 61761 · Mc Lean County

Emergency services Birthing friendly

Methodist Medical Center Of Illinois

Acute Care Hospitals · Peoria, IL

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140209

Location221 N E Glen Oak AvePeoria, IL 61636 · Peoria County

Emergency services Birthing friendly

Carle Eureka Hospital

Critical Access Hospitals · Eureka, IL

OwnershipVoluntary non-profit - Private

CMS Certification Number141309

Location101 S Major StEureka, IL 61530 · Woodford County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61530 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 20

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

9 suppliers60 claims154 services$5.93 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

6 suppliers31 claims40 services$1.05 avg. paid by Medicare

Male external catheter, with or without adhesive, disposable, each A4349

DME-Medical/Surgical Supplies · category DA000N

1 supplier11 claims330 services$1.94 avg. paid by Medicare

Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each A4357

DME-Orthotic Devices · category DF000N

1 supplier11 claims22 services$9.38 avg. paid by Medicare

Tubing with integrated heating element for use with positive airway pressure device A4604