Kelli Potter Brister, NP - Medicare Nurse Practitioner in Jackson, MS

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Kelli Potter Brister, NP is a medicare enrolled "Nurse Practitioner - Family" in Jackson, Mississippi. She graduated from nursing school in 2017 and has 7 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice St. Dominic Medical Associates Llc and her current practice location is 969 Lakeland Dr, Jackson, Mississippi. You can reach out to her office (for appointments etc.) via phone at (601) 200-4644.

Kelli Potter Brister is licensed to practice in Mississippi (license number 902342) 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 1366954240.

Contact Information

Kelli Potter Brister, NP
969 Lakeland Dr,
Jackson, MS 39216-4606
(601) 200-4644
(601) 200-4645

Map and Direction




Provider's Profile

Full NameKelli Potter Brister
GenderFemale
SpecialityNurse Practitioner
Experience7 Years
Location969 Lakeland Dr, Jackson, Mississippi
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Kelli Potter Brister graduated from nursing school in 2017
  NPI Data:
  • NPI Number: 1366954240
  • Provider Enumeration Date: 10/31/2017
  • Last Update Date: 11/29/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 7517224892
  • Enrollment ID: I20171121001316

Medical Identifiers

Medical identifiers for Kelli Potter Brister such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1366954240NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 902342 (Mississippi)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
St Dominic-jackson Memorial HospitalJackson, MSHospital
King's Daughters Medical Center-brookhavenBrookhaven, MSHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
St. Dominic Medical Associates Llc0446303168156

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. Kelli Potter Brister allows following entities to bill medicare on her behalf.
Entity NameSt. Dominic Medical Associates Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1407920549
PECOS PAC ID: 0446303168
Enrollment ID: O20090728000821
Entity NameSt. Dominic Hospital Medicine Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1104362292
PECOS PAC ID: 5597034348
Enrollment ID: O20170711000091
Entity NameNew Palladium Hospice And Palliative Care Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1144792425
PECOS PAC ID: 1759629256
Enrollment ID: O20190207002121

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. Kelli Potter Brister 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 AddressPractice Location Address
Kelli Potter Brister, NP
Po Box 22727,
Jackson, MS 39225-2727

Ph: (601) 200-4749		Kelli Potter Brister, NP
969 Lakeland Dr,
Jackson, MS 39216-4606

Ph: (601) 200-4644

Reviews and Comments


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Jennifer Nichols Foreman, A-GNP-C
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Caryl P. Sumrall, FNP
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Kathryn L. Navarro, NP
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Mr. Bradford Steele Martin, FNP-C
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Phone: 601-984-5500    Fax: 601-984-5503
Mrs. Tiffany Griffin,
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Phone: 601-321-2400    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.