Kelly Payne Smith, NP is a medicare enrolled "Nurse Practitioner" physician in Mequon, Wisconsin. Her current practice location is
10554 N Port Washington Rd, Mequon, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(414) 352-2766.
Kelly Payne Smith is licensed to practice in Wisconsin (license number 7838-33) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1588173199.
Physician's Profile
| Full Name | Kelly Payne Smith |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 10554 N Port Washington Rd, Mequon, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1588173199
- Provider Enumeration Date: 09/26/2017
- Last Update Date: 05/10/2019
Medicare PECOS Information:
- PECOS PAC ID: 7517292972
- Enrollment ID: I20190709000112
Medical Identifiers
Medical identifiers for Kelly Payne Smith such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1588173199 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 207Q00000X | Family Medicine | 7838-33 (Wisconsin) | Secondary |
| 363L00000X | Nurse Practitioner | 7838-33 (Wisconsin) | 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. Kelly Payne Smith allows following entities to bill medicare on her behalf.
| Entity Name | Columbia St Marys Hospital Milwaukee Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1023064482 PECOS PAC ID: 5890604722 Enrollment ID: O20031105000057 |
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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. Kelly Payne Smith 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 |
Kelly Payne Smith, NP 10554 N Port Washington Rd, Mequon, WI 53092-5537 Ph: (414) 352-2766 | Kelly Payne Smith, NP 10554 N Port Washington Rd, Mequon, WI 53092-5537 Ph: (414) 352-2766 |
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