DR. KRISTINE P PULTORAK (D.O.) – Emergency Medicine Physician, NPI 1306814298
Emergency Medicine Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. KRISTINE P PULTORAK (D.O.)
Katherine Shaw Bethea Hospital, 403, East 1st Street, Dixon, Lee County, Illinois, 61021, United States
DIXON, IL 610213116
Phone: (815) 288-5561
Fax: (815) 285-5859
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-06-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101005000077 | I | Emergency Medicine | IL | TBD |
| I20200420002236 | I | Emergency Medicine | WI | TBD |
| I20230607003183 | I | Emergency Medicine | IA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61021)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| - | WI | |
| P S Y C H I A T R Y | IL | |
| - | WI | |
| Internal Medicine | WI | |
| Nurse Practitioner | IL | |
| - | WI | |
| - | WI | |
| - | WI | |
| - | WI |
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