KSB MEDICAL GROUP, INC.
NPI 1073592119
Family Medicine in Dixon, IL

Q: What is Ksb Medical Group, Inc.'s NPI number?

The NPI number for Ksb Medical Group, Inc. is 1073592119. It was assigned to this organization in the NPPES registry on January 16, 2006.

Q: What is Ksb Medical Group, Inc.'s specialty?

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

Active since January 16, 2006

403 E 1ST ST, DIXON, IL 61021(815) 285-5507(815) 285-5859 Get Directions Write a Review

NPPES record last updated: December 28, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Ksb Medical Group, Inc. NPPES

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

KSB MEDICAL GROUP, INC. (NPI 1073592119) is a healthcare organization registered as a family medicine in Dixon, Illinois and active in the NPI registry since January 2006. The organization lists Austin Bruce Frazier, Cfo, as its authorized official.

NPPES Registry Identity

NPI1073592119

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameKSB MEDICAL GROUP, INC.

Location Address403 E 1ST STDixon, IL 61021-3116

Mailing AddressPo Box 841330Kansas City, MO 64184-1330 · (816) 201-3331

Phone(815) 285-5507

Fax(815) 285-5859

Organization SubpartNo

Authorized OfficialAustin Bruce FrazierCfo · (815) 285-5521

Enumeration DateJanuary 16, 2006

Last NPPES UpdateDecember 28, 2022

NPPES CertifiedDecember 28, 2022

✔ NPI 1073592119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 14

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

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.

Also ListedAnesthesiologyTaxonomy 207L00000X

Also ListedEmergency MedicineTaxonomy 207P00000X

Also ListedFamily Medicine · Sports MedicineTaxonomy 207QS0010X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOphthalmologyTaxonomy 207W00000X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedOtolaryngologyTaxonomy 207Y00000X

Also ListedPathology · Anatomic Pathology & Clinical PathologyTaxonomy 207ZP0102X

Also ListedPediatricsTaxonomy 208000000X

403 E 1ST ST, Dixon, IL 61021

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ksb Medical Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

130

Medicare enrollment records show 130 clinicians reassign Medicare billing to Ksb Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 34 practice at this address and 61 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 25

Nurse Practitioner26

Family Practice22

Internal Medicine16

Hospitalist8

Orthopedic Surgery7

Podiatry7

Obstetrics/Gynecology5

Cardiovascular Disease (Cardiology)4

17 other specialties35

Nearest to this location (20)

See all 130

Elivia Ahrens, LCSW

Clinical Social Worker

NPI 1972161750

403 E 1ST ST
Dixon, IL 61021

(815) 285-5638

✔ PECOS✔ Accepts MedicareSame address

Stephanie Berlin, APRN

Nurse Practitioner

NPI 1639786288

403 E 1ST ST
Dixon, IL 61021

(815) 288-5531

✔ PECOS✔ Accepts MedicareSame address

Linda Clemen, NP

Nurse Practitioner

NPI 1437924305

403 E 1ST ST
Dixon, IL 61021

(815) 288-5531

✔ PECOSSame address

Mary Dawtyne, LCSW

Clinical Social Worker

NPI 1740939206

403 E 1ST ST
Dixon, IL 61021

(815) 285-5638

✔ PECOS✔ Accepts MedicareSame address

Brian Didier, MD

Family Practice

NPI 1417521618

403 E 1ST ST
Dixon, IL 61021

(815) 285-5629

✔ PECOS✔ Accepts MedicareSame address

James Gallant, MD

Family Practice

NPI 1295712974

403 E 1ST ST
Dixon, IL 61021

(815) 285-5552

✔ PECOS✔ Accepts MedicareSame address

Sikander Hayat, M.D.

Emergency Medicine

NPI 1902872104

403 E 1ST ST
Dixon, IL 61021

(815) 285-1650

✔ PECOS✔ Accepts MedicareSame address

Jonathan Ortman, M.D.

Emergency Medicine

NPI 1649248204

403 E 1ST ST
Dixon, IL 61021

(815) 285-5552

✔ PECOS✔ Accepts MedicareSame address

Dhruv Patel

Podiatry

NPI 1518644087

403 E 1ST ST
Dixon, IL 61021

(815) 288-5531

✔ PECOSSame address

Marta Van Straten, D.O.

Pathology

NPI 1891006276

403 E. 1ST STREET KATHERINE SHAW BETHEA HOSPITAL
Dixon, IL 61021

(815) 285-5580

✔ PECOS✔ Accepts MedicareSame address

Saad Blaney, M.D.

Pathology

NPI 1003846981

403 E 1ST ST
Dixon, IL 61021

(815) 285-5533

✔ PECOS✔ Accepts MedicareSame address

Abdulhamid Alkhalaf, M.D.

Infectious Disease

NPI 1043237035

215 E 1ST ST STE 310
Dixon, IL 61021

(815) 285-5979

✔ PECOS✔ Accepts MedicareSame address

Cody Elston, AUD

Qualified Audiologist

NPI 1952953176

215 E 1ST ST STE 317
Dixon, IL 61021

(815) 285-5918

Same address

Brandon Gumbiner, DPM

Podiatry

NPI 1154583177

215 E 1ST ST STE 310
Dixon, IL 61021

(815) 285-5801

✔ PECOS✔ Accepts MedicareSame address

Matthew Hefty, M.D.

General Surgery

NPI 1154633618

215 E 1ST ST STE 316
Dixon, IL 61021

(815) 285-5842

✔ PECOS✔ Accepts MedicareSame address

Thomas Hernandez, M.D.

Orthopedic Surgery

NPI 1851513089

215 E 1ST ST STE 326
Dixon, IL 61021

(815) 285-5800

✔ PECOS✔ Accepts MedicareSame address

Eric Simpson, D.O.

Urology

NPI 1134381650

215 E 1ST ST STE 153
Dixon, IL 61021

(815) 285-5484

✔ PECOS✔ Accepts MedicareSame address

Laxman Iyer, M.D.

Internal Medicine

NPI 1891761094

215 E 1ST ST, STE 214
Dixon, IL 61021

(815) 285-5815

✔ PECOSSame address

William Long, D.O.

Obstetrics/Gynecology

NPI 1568430460

215 E 1ST ST
Dixon, IL 61021

(815) 288-7711

✔ PECOS✔ Accepts MedicareSame address

Fadi Mustapha, M.D.

Gastroenterology

NPI 1508801986

215 E 1ST ST
Dixon, IL 61021

(815) 285-5843

✔ PECOS✔ Accepts MedicareSame address

See all 130 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ksb Medical Group, Inc.'s NPI number?

The NPI number for Ksb Medical Group, Inc. is 1073592119. It was assigned to this organization in the NPPES registry on January 16, 2006.

Where is Ksb Medical Group, Inc. located?

Ksb Medical Group, Inc. is located at 403 E 1st St, Dixon, IL 61021. The listed phone number is (815) 285-5507.

What is Ksb Medical Group, Inc.'s specialty?

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

Is Ksb Medical Group, Inc. enrolled in Medicare?

Yes. Ksb Medical Group, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ksb Medical Group, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 130 clinicians in 25 Medicare specialties reassign their Medicare billing to Ksb Medical Group, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (26), Family Practice (22) and Internal Medicine (16). Of these, 34 practice at this address and 61 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Ksb Medical Group, Inc. was last updated on December 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.