Dr Kelly Keefe Nelson, MD is a medicare enrolled "Internal Medicine" physician in Westbrook, Connecticut. His current practice location is
5 Pequot Park Rd, Suite 301, Westbrook, Connecticut. You can reach out to his office (for appointments etc.) via phone at
(860) 399-6167.
Dr Kelly Keefe Nelson is licensed to practice in Connecticut (license number 30067) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1659396737.
Physician's Profile
| Full Name | Dr Kelly Keefe Nelson |
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| Gender | Male |
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| Speciality | Internal Medicine |
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| Location | 5 Pequot Park Rd, Westbrook, Connecticut |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1659396737
- Provider Enumeration Date: 07/12/2006
- Last Update Date: 03/07/2023
Medicare PECOS Information:
- PECOS PAC ID: 1153502943
- Enrollment ID: I20110228000418
Medical Identifiers
Medical identifiers for Dr Kelly Keefe Nelson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659396737 | NPI | - | NPPES |
| 30067 | Other | CT | STATE MEDICAL LICENSE |
| 24371 | Other | CT | STATE DCP |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207R00000X | Internal Medicine | 30067 (Connecticut) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kelly Keefe Nelson allows following entities to bill medicare on his behalf.
| Entity Name | Northeast Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1043278351
PECOS PAC ID: 1254233836
Enrollment ID: O20040123000522 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly Keefe Nelson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Kelly Keefe Nelson, MD
5 Pequot Park Rd, Suite 301,
Westbrook, CT 06498-2856
Ph: (860) 399-6167 | Dr Kelly Keefe Nelson, MD
5 Pequot Park Rd, Suite 301,
Westbrook, CT 06498-2856
Ph: (860) 399-6167 |
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