Individual provider Active NPI

Kacie Renee Lilly, RN, IBCLC

  • Family Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1851064711
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
220428 Issued in OK
Practice address
3400 S Douglas Blvd Ste 200
Oklahoma City, OK 73150-1017
Phone
(405) 272-7000
NPI assigned
Jul 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Registered Nurse) 163WL0100X L-304019 OK
Family Nurse Practitioner 363LF0000X 220428 OK Primary

Addresses

Primary practice location

3400 S Douglas Blvd Ste 200
Oklahoma City, OK 73150-1017

Mailing address

1000 N Lee Ave
Oklahoma City, OK 73102-1080
Phone (405) 272-6207

Other practice location 1

1000 N Lee Ave
Oklahoma City, OK 73102-1080
Phone (405) 272-6207 ext. 6207

Other identifiers 2

IdentifierTypeStateIssuer
220428OtherOKAPRN-CNP
L-304019OtherOKIBCLC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KACIE.LILLY@SSMHEALTH.COM Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20250210002389 OK Practitioner - Nurse Practitioner 4981134624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

3400 S Douglas Blvd
Oklahoma City, OK 73150-1001
Phone (405) 272-2850

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
L-304019OKMDLactation Consultant (Registered Nurse)

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Jan 13, 2025 Accepting new patients
Saints Medical Group, LLC CurrentSince Jan 13, 2025 Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients

Locations

3400 S Douglas Blvd
Ste 200
Oklahoma City, OK 73150
Phone (405) 272-2850

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

777 NW 63rd St
Fl 4
Oklahoma City, OK 73116
Phone (405) 231-3818

3400 S Douglas Blvd
Oklahoma City, OK 73150
Phone (405) 815-5000

1800 S Douglas Blvd
Oklahoma City, OK 73130
Phone (405) 732-7119

Interoperability endpoints

  • Direct secure messaging: klilly66203@direct-ehr-ssmhc.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1851064711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N LEE AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731021080",
            "telephone_number": "405-272-6207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 S DOUGLAS BLVD STE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731501017",
            "telephone_number": "405-272-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 N Lee Ave",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731021080",
            "country_code": "US",
            "telephone_number": "405-272-6207 x6207",
            "fax_number": "405-231-8978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LILLY",
        "first_name": "KACIE",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "RN, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-27",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "OK",
            "license": "L-304019",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "220428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN-CNP",
            "identifier": "220428",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBCLC",
            "identifier": "L-304019",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KACIE.LILLY@SSMHEALTH.COM",
            "affiliation": "N",
            "endpointDescription": "WORK EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1000 N Lee Ave",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731021080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.