Mary Kennedy, is a medicare enrolled "Nurse Practitioner" in Cullom, Illinois. Her current practice location is
105 E Hack St, Cullom, Illinois. You can reach out to her office (for appointments etc.) via phone at
(815) 689-2126.
Mary Kennedy is licensed to practice in Illinois (license number 041127471/209001007) 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 1578656716.
Provider's Profile
| Full Name | Mary Kennedy |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Practitioner |
|---|
| Location | 105 E Hack St, Cullom, Illinois |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1578656716
- Provider Enumeration Date: 10/02/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 5698757037
- Enrollment ID: I20040601001127
Medical Identifiers
Medical identifiers for Mary Kennedy such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1578656716 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363L00000X | Nurse Practitioner | 041127471/209001007 (Illinois) | 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. Mary Kennedy allows following entities to bill medicare on her behalf.
| Entity Name | Saint James Hospital |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1790735421
PECOS PAC ID: 0648187252
Enrollment ID: O20040804001073 |
|---|
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. Mary Kennedy 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 |
|---|
Mary Kennedy,
105 E Hack St,
Cullom, IL 60929
Ph: (815) 689-2126 | Mary Kennedy,
105 E Hack St,
Cullom, IL 60929
Ph: (815) 689-2126 |
Reviews and Comments