NPIMap

Individual provider Active NPI

Kelly Hunt Haller, MD

  • Obstetrics & Gynecology Physician
  • Effingham, IL
National Provider Identifier
1871589382
Registry record updated Mar 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036-086663 Issued in IL
Practice address
912 N Henrietta St
Effingham, IL 62401-1788
Phone
(217) 342-3337
Fax
(217) 342-3338
NPI assigned
Sep 21, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 036-086663 IL Primary

Addresses

Primary practice location

912 N Henrietta St
Effingham, IL 62401-1788

Mailing address

PO Box 784
Effingham, IL 62401-0784
Phone (217) 342-3337

Other identifiers 1

IdentifierTypeStateIssuer
036086663MedicaidIL

Other names 1

  • Kelly Diane Hunt Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101023000260 IL Practitioner - Obstetrics/Gynecology 0446159354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Southern Illinois University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Obstetrics and Gynecology Associates PLLCGroup PAC ID 2961726021, 12 clinicians

Practice addresses (Care Compare)

912 N Henrietta St
Effingham, IL 62401-1788
Phone (217) 342-3337

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-086663ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Effingham Obstetrics and Gynecology Associates PLLC Single Specialty CurrentSince Jan 1, 2015 Accepting new patients

Locations

912 N Henrietta St
Effingham, IL 62401
Phone (217) 342-3337

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/29023/brand/6/csg/101/fhir/r4
  • Direct secure messaging: kelly.haller.1@29023.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
HSHS Hospice IllinoisEffingham, IL, CCN 141658 Hospice Corporate Director Jan 1, 2022
Effingham Obstetrics and Gynecology Associates PLLCEffingham, IL, CCN 783818 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer (50%)
Corporate Director (50%)
Operational/Managerial Control (50%)		 Jan 1, 2015
Jan 1, 2015
Jan 1, 2015
Jan 1, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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 4

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488844800000",
    "number": "1871589382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 784",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624010784",
            "telephone_number": "217-342-3337",
            "fax_number": "217-342-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 N HENRIETTA ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624011788",
            "telephone_number": "217-342-3337",
            "fax_number": "217-342-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLER",
        "first_name": "KELLY",
        "middle_name": "HUNT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2017-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-086663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086663",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HUNT",
            "middle_name": "DIANE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.