Kelly J Slade, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209.011917 Issued in IL

Practice address

176 W Mound Rd
Decatur, IL 62526-1964

Phone

(217) 391-8730

Fax

(217) 391-8731

NPI assigned

Oct 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly J Crispin Former name

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

Merit-based Incentive Payment System (MIPS)

Final score

94.81 of 100Reported as apm

Quality

85.98

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Dolly Briscoe Enterprises, Inc.

  • Health Educator
  • Mt Zion, IL
  • NPI 1447555685
  Medicare reassignment NPD

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1306240767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 W MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625261964",
            "telephone_number": "217-391-8730",
            "fax_number": "217-391-8731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 W MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625261964",
            "telephone_number": "217-391-8730",
            "fax_number": "217-391-8731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLADE",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.011917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CRISPIN",
            "middle_name": "J",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anuj Kumar Singh, MD
• Ranjodh Singh, MD
• Pratibha Singla, M.D.
• Sushant K Sinha, D.O.
• Sista Girls and Friends Incorporated
• Kymesha Slaw, RBT
• Robert J Slusar, DDS
• Jessica L Smiley, LCSW
• Smith Hearing Technologies, LLC
• Abigail Smith

• Nurse Practitioner in Decatur, IL
• Providers in Decatur, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.