Mrs Kellsey R Thole, NP is a medicare enrolled "Nurse Practitioner - Gerontology" physician in O Fallon, Illinois. She graduated from medical school in 2016 and has 8 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Prairie Cardiovascular Consultants Ltd and her current practice location is
Three Saint Elizabeth Blvd Ste 2800, O Fallon, Illinois. You can reach out to her office (for appointments etc.) via phone at
(618) 233-6044.
Mrs Kellsey R Thole is licensed to practice in Illinois (license number 209.015758) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1407397862.
Physician's Profile
| Full Name | Mrs Kellsey R Thole |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 8 Years |
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| Location | Three Saint Elizabeth Blvd Ste 2800, O Fallon, Illinois |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Kellsey R Thole graduated from medical school in 2016
NPI Data:
- NPI Number: 1407397862
- Provider Enumeration Date: 03/17/2017
- Last Update Date: 12/20/2021
Medicare PECOS Information:
- PECOS PAC ID: 4880970375
- Enrollment ID: I20170418001352
Medical Identifiers
Medical identifiers for Mrs Kellsey R Thole such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1407397862 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207RC0000X | Internal Medicine - Cardiovascular Disease | 209.015758 (Illinois) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | 209.015758 (Illinois) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Prairie Cardiovascular Consultants Ltd | 3173435880 | 85 |
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. Mrs Kellsey R Thole allows following entities to bill medicare on her behalf.
| Entity Name | Prairie Cardiovascular Consultants Ltd |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1982714218
PECOS PAC ID: 3173435880
Enrollment ID: O20031103000090 |
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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. Mrs Kellsey R Thole 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 |
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Mrs Kellsey R Thole, NP
Three Saint Elizabeth Blvd Ste 2800,
O Fallon, IL 62269-1282
Ph: (618) 233-6044 | Mrs Kellsey R Thole, NP
Three Saint Elizabeth Blvd Ste 2800,
O Fallon, IL 62269-1282
Ph: (618) 233-6044 |
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