Dr Trace Kelly, FNP-C, DC is a medicare enrolled "Nurse Practitioner - Family" provider in Louisville, Kentucky. His current practice location is
4613 Roxann Blvd Ste 101, Louisville, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(502) 415-3943.
Dr Trace Kelly is licensed to practice in Kentucky (license number 3015925) 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 1629296603.
Healthcare Provider's Profile
| Full Name | Dr Trace Kelly |
|---|
| Gender | Male |
|---|
| Speciality | Nurse Practitioner - Family |
|---|
| Location | 4613 Roxann Blvd Ste 101, Louisville, Kentucky |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1629296603
- Provider Enumeration Date: 04/23/2007
- Last Update Date: 07/07/2021
Medicare PECOS Information:
- PECOS PAC ID: 1850714957
- Enrollment ID: I20200708001426
Medical Identifiers
Medical identifiers for Dr Trace Kelly such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1629296603 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111NR0400X | Chiropractor - Rehabilitation | 4973 (Kentucky) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 3015925 (Kentucky) | 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 Trace Kelly allows following entities to bill medicare on his behalf.
| Provider Name | Stimar Healthcare |
|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
|---|
| Provider Identifiers | NPI Number: 1760051544
PECOS PAC ID: 2062899404
Enrollment ID: O20220524002135 |
|---|
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 Trace Kelly 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 |
|---|
Dr Trace Kelly, FNP-C, DC
4227 Poplar Level Rd,
Louisville, KY 40213-1527
Ph: (502) 451-5959 | Dr Trace Kelly, FNP-C, DC
4613 Roxann Blvd Ste 101,
Louisville, KY 40218-4072
Ph: (502) 415-3943 |
Reviews and Comments