NPIMap

Individual provider Active NPI

Kelly M Farroll, MD

  • Family Medicine Physician
  • Granite City, IL
National Provider Identifier
1063503704
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036093514 Issued in IL
Practice address
2166 Madison Ave
Granite City, IL 62040-4700
Phone
(618) 452-3301
Fax
(618) 452-3312
NPI assigned
Sep 27, 2006
Last updated
Feb 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-093514 IL
Family Medicine Physician 207Q00000X 036093514 IL Primary

Addresses

Primary practice location

2166 Madison Ave
Granite City, IL 62040-4700

Mailing address

2166 Madison Ave
Granite City, IL 62040-4700
Phone (618) 452-3301

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelly.farroll.1@9559.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040327000375 IL Practitioner - Family Practice 9931091592 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lincoln Surgical Associates, LTD.Group PAC ID 9335320597, 25 clinicians

Practice addresses (Care Compare)

2166 Madison Ave
Granite City, IL 62040-4700
Phone (618) 332-0953

739 N Jefferson St
Suite 200
Mascoutah, IL 62258-1447
Phone (618) 566-8810

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-093514ILMDEmergency Medicine Physician
036093514ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation, Inc Family Medicine CurrentSince Mar 9, 2023 Accepting new patients
Southern Illinois Healthcare Foundation Inc Family Medicine Current Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Mar 9, 2023 Accepting new patients
Lincoln Surgical Associates, LTD. Family Medicine CurrentSince Mar 1, 2026 Accepting new patients
Midwest Emergency Management, Inc. Emergency Medicine Past Accepting new patients
Midwest Emergency Department Services Inc Emergency Medicine Past Accepting new patients

Locations

211 S 3rd St
Belleville, IL 62220
Phone (618) 234-2700

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

2166 Madison Ave
Granite City, IL 62040
Phone (618) 219-3318

739 N Jefferson St
#200
Mascoutah, IL 62258
Phone (618) 539-0067

2041 Goose Lake Rd
Sauget, IL 62206

1414 Cross St
Ste 330
Shiloh, IL 62269
Phone (618) 228-8610

Interoperability endpoints

  • Direct secure messaging: kelly.farroll.1@9559.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1063503704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404700",
            "telephone_number": "618-452-3301",
            "fax_number": "618-452-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404700",
            "telephone_number": "618-452-3301",
            "fax_number": "618-452-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARROLL",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-093514",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036093514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.farroll.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2166 Madison Ave",
            "city": "Granite City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620404700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.