Individual provider Active NPI

Melissa K Kenter, APN

  • Family Nurse Practitioner
  • Charleston, IL
National Provider Identifier
1295124766
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
277000346 Issued in IL
Practice address
2040 Lincoln Ave Ste 100
Charleston, IL 61920-3197
Phone
(217) 345-2030
Fax
(217) 345-2045
NPI assigned
Jan 21, 2015
Last updated
Dec 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 277000346 IL Primary

Addresses

Primary practice location

2040 Lincoln Ave Ste 100
Charleston, IL 61920-3197

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

1100 Tuscola Blvd
Tuscola, IL 61953-2065
Phone (217) 253-4764

Other practice location 2

1303 W Evergreen Ave Ste 201
Effingham, IL 62401-1638
Phone (217) 347-1422

Other practice location 3

1201 Wooddell Way Ste B
Mattoon, IL 61938-1014
Phone (217) 238-3000

Other practice location 4

1303 W Evergreen Ave Ste 100
Effingham, IL 62401-1638
Phone (217) 540-6123

Other names 1

  • Melissa K Paholke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150325000329 IL Practitioner - Nurse Practitioner 7315264652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

101 Professional PLZ
Mattoon, IL 61938-9252
Phone (217) 238-3730

1303 W Evergreen Ave
Effingham, IL 62401-1638

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
277000346ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Feb 26, 2015 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Feb 26, 2015 Accepting new patients
Sarah Bush Lincoln Health Center Past Accepting new patients

Locations

2040 Lincoln Ave
Ste 100
Charleston, IL 61920
Phone (217) 345-2030

1303 W Evergreen Ave
Ste 100
Effingham, IL 62401
Phone (217) 540-6123

1303 W Evergreen Ave
Ste 200
Effingham, IL 62401
Phone (217) 342-3400

1303 W Evergreen Ave
Ste 201
Effingham, IL 62401
Phone (217) 347-1422

1000 Red Ball Trl
Greenville, IL 62246
Phone (618) 391-6495

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1201 Wooddell Way
Ste B
Mattoon, IL 61938
Phone (217) 238-3000

1100 Tuscola Blvd
Tuscola, IL 61953
Phone (217) 253-2020

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1295124766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 LINCOLN AVE STE 100",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203197",
            "telephone_number": "217-345-2030",
            "fax_number": "217-345-2045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Tuscola Blvd",
            "address_purpose": "LOCATION",
            "city": "Tuscola",
            "state": "IL",
            "postal_code": "619532065",
            "country_code": "US",
            "telephone_number": "217-253-4764",
            "fax_number": "217-253-4886",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1303 W Evergreen Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624011638",
            "country_code": "US",
            "telephone_number": "217-347-1422",
            "fax_number": "217-342-3402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Wooddell Way Ste B",
            "address_purpose": "LOCATION",
            "city": "Mattoon",
            "state": "IL",
            "postal_code": "619381014",
            "country_code": "US",
            "telephone_number": "217-238-3000",
            "fax_number": "217-238-3008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1303 W Evergreen Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624011638",
            "country_code": "US",
            "telephone_number": "217-540-6123",
            "fax_number": "217-347-4969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENTER",
        "first_name": "MELISSA",
        "middle_name": "K",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-21",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "PAHOLKE",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, IL

Sources for this page

Verify at the official NPI Registry.