Mary Kennedy, is a medicare enrolled "Nurse Practitioner" in Cullom, Illinois. Her current practice location is
105 E Hack St, Cullom, Illinois. You can reach out to her office (for appointments etc.) via phone at
(815) 689-2126.
Mary Kennedy is licensed to practice in Illinois (license number 041127471/209001007) 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 1578656716.
Provider's Profile
Full Name | Mary Kennedy |
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Gender | Female |
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Speciality | Nurse Practitioner |
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Location | 105 E Hack St, Cullom, Illinois |
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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: 1578656716
- Provider Enumeration Date: 10/02/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 5698757037
- Enrollment ID: I20040601001127
Medical Identifiers
Medical identifiers for Mary Kennedy such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1578656716 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363L00000X | Nurse Practitioner | 041127471/209001007 (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. Mary Kennedy allows following entities to bill medicare on her behalf.
Entity Name | Saint James Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1790735421 PECOS PAC ID: 0648187252 Enrollment ID: O20040804001073 |
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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. Mary Kennedy 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 |
Mary Kennedy, 105 E Hack St, Cullom, IL 60929 Ph: (815) 689-2126 | Mary Kennedy, 105 E Hack St, Cullom, IL 60929 Ph: (815) 689-2126 |
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