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KERI DOUGLAS FNP-BC
NPI 1104201714
Nurse Practitioner in Centrailia, IL

Active since July 24, 2015PECOS Enrolled
1054 M. L. KING DRIVE #125, CENTRAILIA, IL 62801(618) 436-5200 Get Directions Write a Review

NPPES record last updated: July 24, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Keri Douglas Fnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KERI DOUGLAS FNP-BC (NPI 1104201714) is an individual nurse practitioner in Centrailia, Illinois, licensed in Illinois (209.012941) and active in the NPI registry since July 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104201714
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameKERI DOUGLASCredential: FNP-BC
Location Address1054 M. L. KING DRIVE #125Centrailia, IL 62801
Mailing Address197 Westmore DriveAviston, IL 62216 · (618) 560-8797
Phone(618) 436-5200
Sole ProprietorNo
Enumeration DateJuly 24, 2015
✔ NPI 1104201714 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in IL · 209.012941
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keri Douglas Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Keri Douglas reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Physician Services Corporation Of Southern Illinois Inc.
Internal Medicine
4218 LINCOLNSHIRE DR
Mount Vernon, IL 62864
  • Reassigned Medicare billing, Illinois enrollment
  • 296 clinicians in this Medicare group
NPI 1831101807 (618) 899-3600
St. Mary's Hospital, Centralia, Illinois
Anesthesiology
400 N PLEASANT AVE
Centralia, IL 62801
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: St Marys Hospital Centralia Illinois
  • 392 clinicians in this Medicare group
NPI 1477097871 (618) 436-6056

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62801 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keri Douglas's NPI number?

The NPI number for Keri Douglas is 1104201714. It was assigned to this individual provider in the NPPES registry on July 24, 2015.

Where is Keri Douglas located?

Keri Douglas practices at 1054 M. L. King Drive #125, Centrailia, IL 62801. The listed phone number is (618) 436-5200.

What is Keri Douglas's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Keri Douglas enrolled in Medicare?

Yes. Keri Douglas is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Keri Douglas's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Keri Douglas reassigns Medicare benefits to 2 organizations: Physician Services Corporation Of Southern Illinois Inc. (Mount Vernon, IL) and St. Mary's Hospital, Centralia, Illinois (Centralia, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Keri Douglas's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Keri Douglas was last updated on July 24, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.