KELLY A. ROURKE (M.D.) – Internal Medicine Physician, NPI 1033185285
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KELLY A. ROURKE (M.D.)
108 GATEWAY COMMERCE CENTER DR N
EDWARDSVILLE, IL 620252818
Phone: (618) 219-7470
Type: Location
Old Tesson Road, Concord, Saint Louis County, Missouri, 63128, United States
SUITE 240
SAINT LOUIS, MO 631282251
Phone: (314) 467-3900
Fax: (314) 467-3919
Type: Mailing
PO BOX 776084
CHICAGO, IL 606776084
Phone: (618) 219-7470
Fax: (618) 219-7469
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-05-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070524000383 | I | Internal Medicine | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62025)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| INTERNAL MEDICINE | MO | 81002 | Urinalysis, manual test | 30 | 25 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO |
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