Individual provider Active NPI

Kelly Ann Durst-Sharpe, O.D.

  • Optometrist
  • Quincy, IL
National Provider Identifier
1447632187
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046011066 Issued in IL
Practice address
1125 Hampshire St
Quincy, IL 62301-3026
Phone
(217) 222-6550
Fax
(217) 277-2253
NPI assigned
Jun 18, 2015
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2015019033 MO
Optometrist 152W00000X 046011066 IL Primary

Addresses

Primary practice location

1125 Hampshire St
Quincy, IL 62301-3026

Mailing address

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

Other practice location 1

1702 N Baltimore St
Kirksville, MO 63501-2485
Phone (660) 665-6262

Other practice location 2

1702 N Baltimore St
Kirksville, MO 63501-2485
Phone (660) 665-6262

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170511001107 IL Practitioner - Optometry 5496067118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1125 Hampshire St
Quincy, IL 62301-3026
Phone (217) 222-6550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046011066ILMDOptometrist
2015019033MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Current Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Dec 29, 2017 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Dec 29, 2017 Accepting new patients

Locations

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

1125 Hampshire St
Quincy, IL 62301
Phone (217) 222-3937

Interoperability endpoints

  • Direct secure messaging: kdurstsharpe600558@direct.unitypoint.org

Organizations & group practices 4

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": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1447632187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 HAMPSHIRE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013026",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1702 N Baltimore St",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635012485",
            "country_code": "US",
            "telephone_number": "660-665-6262",
            "fax_number": "660-665-5908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1702 N Baltimore St",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635012485",
            "country_code": "US",
            "telephone_number": "660-665-6262",
            "fax_number": "660-665-5908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DURST-SHARPE",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2015019033",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.