NPIMap

Individual provider Active NPI

Kelsey Marie Thacker

  • Nurse Practitioner
  • Mt Zion, IL
National Provider Identifier
1245765296
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209015926 Issued in IL
Practice address
104 E Ashland Ave
Mt Zion, IL 62549-1271
Phone
(217) 864-2665
Fax
(217) 864-8042
NPI assigned
Apr 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209015926 IL Primary

Addresses

Primary practice location

104 E Ashland Ave
Mt Zion, IL 62549-1271

Mailing address

104 Ashland Avenue
Mt. Zion, IL 62549
Phone (217) 864-2665

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
I20170517002865 IL Practitioner - Nurse Practitioner 6002183381 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Decatur Orthopedic Center LLC 9 clinicians

Practice addresses (Care Compare)

104 E Ashland Ave
Mt Zion, IL 62549-1271
Phone (217) 864-2665

Hospital & facility affiliations

  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
  • St Anthonys Memorial Hospital Hospital, Effingham, IL, CCN 140032
  • St Marys Hospital Hospital, Decatur, IL, CCN 140166

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.5 of 100Reported as group
Quality
85.2
Improvement activities
40
Cost
68.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209015926ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pana Community Hospital Association CurrentSince Dec 1, 2020 Accepting new patients
Kirby Medical Center CurrentSince Sep 6, 2017 Accepting new patients
Pana Community Hospital Association CurrentSince Dec 1, 2025 Accepting new patients
Decatur Orthopedic Center, LLC CurrentSince May 9, 2017 Accepting new patients
Pana Community Hospital Association CurrentSince Dec 1, 2020 Accepting new patients
Kirby Medical Center CurrentSince Sep 6, 2017 Accepting new patients
Kirby Medical Center Past Accepting new patients
Pana Community Hospital Association Past Accepting new patients

Locations

1000 Medical Center Dr
Monticello, IL 61856
Phone (217) 762-1540

1000 Medical Center Dr
Ste A
Monticello, IL 61856

104 E Ashland Ave
Mt Zion, IL 62549
Phone (217) 864-2665

101 E 9th St
Ste 105
Pana, IL 62557
Phone (217) 562-2544

101 E 9th St
Pana, IL 62557
Phone (217) 562-2131

Interoperability endpoints

  • Direct secure messaging: kelseythacker@docenter.allscriptsdirect.net

Organizations & group practices 8

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

Hospital & facility affiliations 4

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": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1245765296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ASHLAND AVENUE",
            "city": "MT. ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-2665",
            "fax_number": "217-864-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E ASHLAND AVE",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491271",
            "telephone_number": "217-864-2665",
            "fax_number": "217-864-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2017-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Zion, IL

Sources for this page

Verify at the official NPI Registry.