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MALLORY KELLY M.D.
NPI 1174938690
Internal Medicine in Washington, IL

Active since June 23, 2014PECOS Enrolled
1113 DIXON ST, WASHINGTON, IL 61571(217) 502-2672 Get Directions Write a Review

NPPES record last updated: June 23, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mallory Kelly M.d. NPPES

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

MALLORY KELLY M.D. (NPI 1174938690) is an individual internal medicine provider in Washington, Illinois, licensed in Illinois (125.064460) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174938690
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameMALLORY KELLYCredential: M.D.
Location Address1113 DIXON STWashington, IL 61571-9004
Mailing Address1113 Dixon StWashington, IL 61571-9004 · (217) 502-2672
Phone(217) 502-2672
Sole ProprietorNo
Enumeration DateJune 23, 2014
✔ NPI 1174938690 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in IL · 125.064460
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X · License 125.064460 (IL)
1113 DIXON ST, Washington, IL 61571
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallory Kelly M.d. 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 Reassignment

Medicare enrollment records show Mallory Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Saint Francis Medical Center
8.8 mi
Neurology
530 NE GLEN OAK AVE
Peoria, IL 61637
  • Reassigned Medicare billing, Illinois enrollment
  • 157 clinicians in this Medicare group
NPI 1154370195 (309) 655-2000

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 61571 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
$127.46 typical visit price
range $54.80 – $168.44
Typical copayment $31.86 (range $13.70 – $42.11)
Most-billed visit code 99204
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.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
5 suppliers13 claims23 services$3.46 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Mallory Kelly's NPI number?

The NPI number for Mallory Kelly is 1174938690. It was assigned to this individual provider in the NPPES registry on June 23, 2014.

Where is Mallory Kelly located?

Mallory Kelly practices at 1113 Dixon St, Washington, IL 61571. The listed phone number is (217) 502-2672.

What is Mallory Kelly's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Mallory Kelly enrolled in Medicare?

Yes. Mallory Kelly is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mallory Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Kelly reassigns Medicare benefits to Saint Francis Medical Center (Peoria, IL). The 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 Mallory Kelly'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 Mallory Kelly was last updated on June 23, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.