DEREK G KENNEASTER (MD) – Dermatology Physician, NPI 1457372724
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
703 DERMATOLOGY in IL
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Provider Addresses for DEREK G KENNEASTER (MD)
220, North Park Avenue, Chittyville, Herrin, Williamson County, Illinois, 62948, United States
SUITE 2
HERRIN, IL 629483150
Phone: (618) 942-3344
Fax: (618) 942-5045
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)
CMS reports 28 Open Payments records for all available years, with a total value of $717.
Total Amount is formed as General ($717) + Research ($0) + Ownership ($0) = $717.
Last reported payment date: 2024-10-25 • Largest payer in this snapshot: Regeneron Healthcare Solutions, Inc. ($125).
Total Amount
$717
General + Research + Ownership
Payments
28
Total payment records
General Amount
$717
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-25
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2010-11-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20101124000877 | I | Dermatology | IL | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 2,732 | 350 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1,075 | 580 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 756 | 432 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 539 | 383 | $0 |
| 11103 | Biopsy of related skin growth, each additional growth | 339 | 210 | $0 |
Insurance plans in this area (ZIP 62948)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IL | |
| - | IN | |
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| P A T H O L O G Y | IN | |
| - | IL | |
| Physician Assistant | MO | |
| - | IL | |
| Nurse Practitioner | IL | |
| D E R M A T O L O G Y | IL |
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