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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