Ms Kelly Cotaleen Todd, PNP is a medicare enrolled "Nurse Practitioner - Pediatrics" in Walnut, Illinois. Her current practice location is
25340 1300 East St, Walnut, Illinois. You can reach out to her office (for appointments etc.) via phone at
(815) 310-6222.
Ms Kelly Cotaleen Todd is licensed to practice in Illinois (license number 277001500) 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 1538656145.
Provider's Profile
| Full Name | Ms Kelly Cotaleen Todd |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Pediatrics |
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| Location | 25340 1300 East St, Walnut, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1538656145
- Provider Enumeration Date: 04/18/2018
- Last Update Date: 08/02/2022
Medicare PECOS Information:
- PECOS PAC ID: 6204185960
- Enrollment ID: I20220224001347
Medical Identifiers
Medical identifiers for Ms Kelly Cotaleen Todd such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1538656145 | NPI | - | NPPES |
| 420071827 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | MCS006520B (Massachusetts) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 2018004205 (Missouri) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 277001500 (Illinois) | 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 Kelly Cotaleen Todd allows following entities to bill medicare on her behalf.
| Entity Name | Washington University Physicians In Illinois, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1477076263
PECOS PAC ID: 4789945163
Enrollment ID: O20180227002018 |
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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. Ms Kelly Cotaleen Todd 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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Ms Kelly Cotaleen Todd, PNP
2646 Park Ave,
Saint Louis, MO 63104-2024
Ph: (815) 310-6222 | Ms Kelly Cotaleen Todd, PNP
25340 1300 East St,
Walnut, IL 61376-9274
Ph: (815) 310-6222 |
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