MRS. KELLSEY R THOLE NP
NPI 1407397862
Nurse Practitioner - Gerontology in O Fallon, IL
About Mrs. Kellsey R Thole Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. KELLSEY R THOLE NP (NPI 1407397862) is an individual gerontology provider in O Fallon, Illinois, licensed in Illinois (209.015758) and active in the NPI registry since March 2017. She is enrolled in Medicare PECOS, is affiliated with Ssm Health St Mary's Hospital -centralia, and is a graduate of Other (2016).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mrs. Kellsey R Thole Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Kellsey Thole reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Springfield, IL 62704
- Reassigned Medicare billing, Illinois enrollment
- 101 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 4
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Ssm Health St Mary's Hospital -Centralia
Acute Care Hospitals · Centralia, ILHshs Holy Family Hospital Inc
Acute Care Hospitals · Greenville, ILSt Josephs Hospital
Acute Care Hospitals · Breese, ILHshs St Elizabeth's Hospital
Acute Care Hospitals · O Fallon, ILPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 62269 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 15
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
O FALLON, IL 62269
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 Kellsey Thole's NPI number?
The NPI number for Kellsey Thole is 1407397862. It was assigned to this individual provider in the NPPES registry on March 17, 2017.
Where is Kellsey Thole located?
Kellsey Thole practices at Three Saint Elizabeth Blvd Ste 2800, O Fallon, IL 62269. The listed phone number is (618) 233-6044.
What is Kellsey Thole's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Kellsey Thole enrolled in Medicare?
Yes. Kellsey Thole is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Kellsey Thole's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kellsey Thole reassigns Medicare benefits to Prairie Cardiovascular Consultants Ltd (Springfield, 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 Kellsey Thole's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kellsey Thole accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health and UnitedHealthcare list Kellsey Thole as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Kellsey Thole affiliated with any hospitals?
According to CMS data, Kellsey Thole is affiliated with Ssm Health St Mary's Hospital -Centralia, Hshs Holy Family Hospital Inc, St Josephs Hospital and Hshs St Elizabeth's Hospital.
When was this NPI record last updated?
The NPPES record for Kellsey Thole was last updated on December 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mrs. Kellsey R Thole, NP · NPI 1407397862
Gerontology physician in O Fallon, Illinois. Individual provider, active in the CMS NPPES registry since March 17, 2017.
## Identity
- **NPI:** 1407397862 (Entity type: Individual)
- **Enumerated:** March 17, 2017
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **State license:** 209.015758 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** THREE SAINT ELIZABETH BLVD STE 2800, O Fallon, IL 62269-1282
- **Phone:** (618) 233-6044 · **Fax:** (833) 973-4218
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Prairie Cardiovascular Consultants Ltd (NPI 1982714218, Springfield, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2016
## Record status
- **NPPES last updated:** December 20, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1407397862) · Data from the CMS NPPES public registry.