Keri Douglas, FNP-BC is a medicare enrolled "Nurse Practitioner" in Centrailia, Illinois. Her current practice location is
1054 M. L. King Drive #125, Centrailia, Illinois. You can reach out to her office (for appointments etc.) via phone at
(618) 436-5200.
Keri Douglas is licensed to practice in Illinois (license number 209.012941) 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 1104201714.
Provider's Profile
| Full Name | Keri Douglas |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 1054 M. L. King Drive #125, Centrailia, 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: 1104201714
- Provider Enumeration Date: 07/24/2015
- Last Update Date: 07/24/2015
Medicare PECOS Information:
- PECOS PAC ID: 0547575599
- Enrollment ID: I20150819008737
Medical Identifiers
Medical identifiers for Keri Douglas such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104201714 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 209.012941 (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. Keri Douglas allows following entities to bill medicare on her behalf.
| Entity Name | St Marys Hospital Centralia Illinois |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770687196
PECOS PAC ID: 6709788920
Enrollment ID: O20040127000118 |
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| Entity Name | Physician Services Corporation Of Southern Illinois Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1831101807
PECOS PAC ID: 9234022567
Enrollment ID: O20040304000583 |
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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. Keri Douglas 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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Keri Douglas, FNP-BC
197 Westmore Drive,
Aviston, IL 62216
Ph: (618) 560-8797 | Keri Douglas, FNP-BC
1054 M. L. King Drive #125,
Centrailia, IL 62801
Ph: (618) 436-5200 |
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