Ms Kally Ann Petka, FNP in Southbridge, MA - Medicare Nurse Practitioner

Ms Kally Ann Petka, FNP is a medicare enrolled "Nurse Practitioner - Family" in Southbridge, Massachusetts. Her current practice location is 100 South St, Southbridge, Massachusetts. You can reach out to her office (for appointments etc.) via phone at (508) 765-9771.

Ms Kally Ann Petka is licensed to practice in Massachusetts (license number RN2277628) 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 1548892326.

Contact Information

	Ms Kally Ann Petka, FNP
	100 South St, Southbridge, MA 01550-4051
	(508) 765-9771
	Not Available

Map and Direction

Provider's Profile

Full Name	Ms Kally Ann Petka
Gender	Female
Speciality	Nurse Practitioner - Family
Location	100 South St, Southbridge, Massachusetts
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1548892326
Provider Enumeration Date: 02/10/2020
Last Update Date: 01/30/2025

Medicare PECOS Information:

PECOS PAC ID: 5991133126
Enrollment ID: I20200320002208

Medical Identifiers

Medical identifiers for Ms Kally Ann Petka such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1548892326	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	RN2277628 (Massachusetts)	Secondary
363LF0000X	Nurse Practitioner - Family	RN2277628 (Massachusetts)	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. Ms Kally Ann Petka allows following entities to bill medicare on her behalf.

Entity Name	Umass Memorial Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1760445373 PECOS PAC ID: 4284539891 Enrollment ID: O20040113000267

Entity Name	Umass Memorial Health-harrington Hospital Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1790780047 PECOS PAC ID: 8123087319 Enrollment ID: O20041004001081

Entity Name	Signify Health Medical Associates Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1750845863 PECOS PAC ID: 2163764424 Enrollment ID: O20200204002341

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. Ms Kally Ann Petka 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
Ms Kally Ann Petka, FNP 100 South St Ste 1, Southbridge, MA 01550-4047 Ph: (508) 765-9771	Ms Kally Ann Petka, FNP 100 South St, Southbridge, MA 01550-4051 Ph: (508) 765-9771

Reviews and Comments

Nurse Practitioner Nurses in Southbridge, MA

Mr. Chukwuemeka Peter Asiegbu, PMHNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 29 Pine St, Southbridge, MA 01550 Phone: 508-765-9167 Fax: 508-764-2462
Paulette Remijan, APN-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 South St, Comprecare, Southbridge, MA 01550 Phone: 508-765-3093 Fax: 508-765-3047
Cindy Porter, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 South Street, Southbridge, MA 01550 Phone: 508-765-9771 Fax: 508-909-7735
George M Gachuma, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 29 Pine St, Southbridge, MA 01550 Phone: 508-765-9167
Courtney Lynn Cowell, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 55 Sayles St, Southbridge, MA 01550 Phone: 508-764-2400 Fax: 508-909-7770
Agata Marta Menard, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 29 Pine St, Southbridge, MA 01550 Phone: 508-765-9167
Allison Doreen Read, RN, PMHNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 South Street, Southbridge, MA 01550 Phone: 508-765-9771

Ms Kally Ann Petka, FNP - Medicare Nurse Practitioner in Southbridge, MA