Individual provider Active NPI

Kelli Meyer, MD

  • Emergency Medicine Physician
  • Springfield, IL
National Provider Identifier
1508607110
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
125.084069 Issued in IL
Practice address
701 N 1St St Ste D220
Springfield, IL 62702-3757
Phone
(217) 545-3518
NPI assigned
Jun 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125.084069 IL Primary

Addresses

Primary practice location

701 N 1St St Ste D220
Springfield, IL 62702-3757

Mailing address

PO Box 19679
Springfield, IL 62794-9679
Phone (217) 545-3518

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240724001096 IL Order and Referring Only - Emergency MedicinePractitioner - Emergency Medicine 3476099656

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.084069ILMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1508607110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19679",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949679",
            "telephone_number": "217-545-3518",
            "fax_number": "217-545-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST STE D220",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627023757",
            "telephone_number": "217-545-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEYER",
        "first_name": "KELLI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.084069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.