Kellsey R Thole, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209.015758 Issued in IL

Practice address

Three Saint Elizabeth Blvd Ste 2800
O Fallon, IL 62269-1282

Phone

(618) 233-6044

Fax

(833) 973-4218

NPI assigned

Mar 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prairie Cardiovascular Consultants LTDGroup PAC ID 3173435880, 94 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
• St Josephs Hospital Hospital, Breese, IL, CCN 140145
• HSHS Holy Family Hospital Inc Hospital, Greenville, IL, CCN 140137
• SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034

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

Interoperability endpoints

• Direct secure messaging: ktebbe100200@ewd.direct.hshs.org

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.

• Prairie Cardiovascular Consultants LTD

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1982714218

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Cardiology Consultants LTD

  • Cardiovascular Disease Physician
  • Belleville, IL
  • NPI 1821015819
  NPD (past)

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

• HSHS Holy Family Hospital Inc

  • General Acute Care Hospital
  • Greenville, IL
  • NPI 1205850690
  Care Compare affiliation
• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302
  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  • Rural Health Clinic/Center
  • Breese, IL
  • NPI 1013002658

  Hospital

  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  • General Acute Care Hospital
  • Breese, IL
  • NPI 1457319154
  Care Compare affiliation
• St Mary'S Hospital, Centralia, Illinois

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation

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

{
    "created_epoch": "1489708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1407397862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "THREE SAINT ELIZABETH BLVD STE 2800",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691282",
            "telephone_number": "618-233-6044",
            "fax_number": "833-973-4218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THREE SAINT ELIZABETH BLVD STE 2800",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691282",
            "telephone_number": "618-233-6044",
            "fax_number": "833-973-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOLE",
        "first_name": "KELLSEY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-17",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "209.015758",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.015758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ktebbe100200@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "Three Saint Elizabeth Blvd Ste 2800",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622691282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Gerontology Nurse Practitioner in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; 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.