Kelly Cotaleen Todd, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

277001500 Issued in IL

Practice address

25340 1300 East St
Walnut, IL 61376-9274

Phone

(815) 310-6222

NPI assigned

Apr 18, 2018

Sex

Female

Sole proprietor

No

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.

• Washington University Physicians in Illinois, Inc

  • Multi-Specialty Clinic/Center
  • O Fallon, IL
  • NPI 1477076263

  IL

  Medicare reassignment NPD
• Hope Chest Pediatrics LLC

  • Pediatrics Physician
  • Marine, IL
  • NPI 1801511290
  NPD Authorized official
• Washington University Physicians in Illinois, Inc

  • Multi-Specialty Clinic/Center
  • Swansea, IL
  • NPI 1871132449
  NPD
• Washington University Physicians in Illinois, Inc

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1457203135
  NPD
• PM Pediatrics of New England LLC

  • Urgent Care Clinic/Center
  • Woburn, MA
  • NPI 1346871183
  NPD (past)
• PM Pediatrics of New England LLC

  • Urgent Care Clinic/Center
  • Braintree, MA
  • NPI 1366108946
  NPD (past)
• PM Pediatrics of New England LLC

  • Urgent Care Clinic/Center
  • Saugus, MA
  • NPI 1477378123
  NPD (past)
• PM Pediatrics of New England LLC

  • Pediatrics Physician
  • Dedham, NY
  • NPI 1851828107
  NPD (past)

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25014/brand/1/csg/1/fhir/r4
• Direct secure messaging: kelly.todd.1@25014.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 2, 2022.

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1538656145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631042024",
            "telephone_number": "815-310-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25340 1300 EAST ST",
            "city": "WALNUT",
            "state": "IL",
            "postal_code": "613769274",
            "telephone_number": "815-310-6222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TODD",
        "first_name": "KELLY",
        "middle_name": "COTALEEN",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-18",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "MCS006520B",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2018004205",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "277001500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420071827",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NPKelly@hopechestpediatrics.com",
            "affiliation": "N",
            "endpointDescription": "practice email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "25340 1300 East St",
            "city": "Walnut",
            "state": "IL",
            "country_code": "US",
            "postal_code": "613769274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dean A Hulsing, D.C.
• Colton Ronald Johnson, MD
• Julia Rackley Perry Memorial Hospital
• Julia Rackley Perry Memorial Hospital
• Aspen Quadri
• Heidi Allison Wilken Wallace, LCSW
• Walnut Fire Department Inc
• Walnut Fire Protection District

• All providers in Walnut, IL
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.