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DR. FREDERICK J PFALZGRAF M.D.
NPI 1659385581
Internal Medicine - Rheumatology in Herrin, IL

Active since July 28, 2006PECOS EnrolledAccepts Medicare Assignment
408 LINCOLN DR, SUITE A, HERRIN, IL 62948(618) 993-1408 Get Directions Write a Review

NPPES record last updated: June 24, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Frederick J Pfalzgraf M.d. NPPES

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

DR. FREDERICK J PFALZGRAF M.D. (NPI 1659385581) is an individual rheumatology provider in Herrin, Illinois, licensed in Illinois (036102694) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Pinckneyville Community Hospital, and maintains a secondary practice location in Sparta.

NPPES Registry Identity

NPI1659385581
Entity TypeIndividualMale
Primary Taxonomy207RR0500X
Provider Legal NameDR. FREDERICK J PFALZGRAFCredential: M.D.
Location Address408 LINCOLN DR, SUITE AHerrin, IL 62948-3790
Mailing AddressPo Box 2963Carbondale, IL 62902-2963 · (618) 993-1408
Phone(618) 993-1408
Sole ProprietorYes
Medical School CMSUniversity Of Wisconsin School Of MedicineGraduated 1991
Enumeration DateJuly 28, 2006
Last NPPES UpdateJune 24, 2020
NPPES CertifiedJune 24, 2020
✔ NPI 1659385581 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
License✔ Licensed in IL · 036102694
Definition
An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
408 LINCOLN DR, Herrin, IL 62948
Open in Google Maps ↗

Secondary Practice Location 1

Location 1207 S Burns AveSparta, IL 62286-1867 · Phone (618) 443-3084 · Fax (618) 443-1348

Other Identifiers 1

Medicaid036102694IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Frederick J Pfalzgraf M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032116868
PECOS Enrollment IDI20061108000526, I20170131001019
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.

Medicare Billing Reassignments

4

Medicare enrollment records show Frederick Pfalzgraf reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Franklin Hospital District
19 mi
Critical Access
201 BAILEY LANE
Benton, IL 62812
  • Reassigned Medicare billing, Illinois enrollment
  • Also billed through NPI 1255369427 (Illinois)
  • 34 clinicians in this Medicare group
NPI 1699778951 (618) 439-3161
Marshall Browning Hospital Association
22 mi
Critical Access
900 N WASHINGTON ST, BOX 192
Du Quoin, IL 62832
  • Reassigned Medicare billing, Illinois enrollment
  • 47 clinicians in this Medicare group
NPI 1821099441 (618) 542-2146
Ferrell Hospital Community Foundation
27 mi
Multi-Specialty
HARRISBURG SMALL STREET CLINIC, 250 SMALL STREET
Harrisburg, IL 62946
  • Reassigned Medicare billing, Illinois enrollment
  • 74 clinicians in this Medicare group
NPI 1124905351 (618) 294-8264
Mercy Hospital Perry
34 mi
Critical Access
434 N WEST ST
Perryville, MO 63775
  • Reassigned Medicare billing, Missouri enrollment
  • 192 clinicians in this Medicare group
NPI 1063117158 (417) 820-8439

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

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
188 services90 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
19 services19 patients

Hospital Affiliations CMS Care Compare 5

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

Pinckneyville Community Hospital

Critical Access Hospitals · Pinckneyville, IL
OwnershipGovernment - Hospital District or Authority
CMS Certification Number141307
Location5383 State Route 154Pinckneyville, IL 62274 · Perry County
Emergency services

Franklin Hospital

Critical Access Hospitals · Benton, IL
OwnershipGovernment - Hospital District or Authority
CMS Certification Number141321
Location201 Bailey LaneBenton, IL 62812 · Franklin County
Emergency services

Ferrell Hospital Community Foundations

Critical Access Hospitals · Eldorado, IL
OwnershipVoluntary non-profit - Private
CMS Certification Number141324
Location1201 Pine StreetEldorado, IL 62930 · Saline County
Emergency services

Marshall Browning Hospital

Critical Access Hospitals · Du Quoin, IL
OwnershipVoluntary non-profit - Private
CMS Certification Number141331
Location900 North Washington StreetDu Quoin, IL 62832 · Perry County
Emergency services

Mercy Hospital Perry

Critical Access Hospitals · Perryville, MO
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number261311
Location434 North West StreetPerryville, MO 63775 · Perry County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62948 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
$127.46 typical visit price
range $54.80 – $168.44
Typical copayment $31.86 (range $13.70 – $42.11)
Most-billed visit code 99204
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.

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 Frederick Pfalzgraf's NPI number?

The NPI number for Frederick Pfalzgraf is 1659385581. It was assigned to this individual provider in the NPPES registry on July 28, 2006.

Where is Frederick Pfalzgraf located?

Frederick Pfalzgraf practices at 408 Lincoln Dr Suite A, Herrin, IL 62948. The listed phone number is (618) 993-1408.

What is Frederick Pfalzgraf's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Is Frederick Pfalzgraf enrolled in Medicare?

Yes. Frederick Pfalzgraf is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Frederick Pfalzgraf's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Frederick Pfalzgraf reassigns Medicare benefits to 4 organizations: Franklin Hospital District (Benton, IL), Marshall Browning Hospital Association (Du Quoin, IL), Ferrell Hospital Community Foundation (Harrisburg, IL) and Mercy Hospital Perry (Perryville, MO). Each 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 Frederick Pfalzgraf's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Frederick Pfalzgraf accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 4 other insurers list Frederick Pfalzgraf as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Frederick Pfalzgraf affiliated with any hospitals?

According to CMS data, Frederick Pfalzgraf is affiliated with Pinckneyville Community Hospital, Franklin Hospital, Ferrell Hospital Community Foundations, Marshall Browning Hospital and Mercy Hospital Perry.

When was this NPI record last updated?

The NPPES record for Frederick Pfalzgraf was last updated on June 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.