DR. KALLIE LOUISE HARRISON (M.D.) – Obstetrics & Gynecology Physician, NPI 1104118249

DR. KALLIE LOUISE HARRISON (M.D.) is a healthcare provider. based in Belleville, Illinois. specializing in OBSTETRICS/GYNECOLOGY. They hold the professional credentials M.D.. They hold a License No. 036-137005 (IL). The NPI Number for DR. KALLIE LOUISE HARRISON (M.D.) is 1104118249

Main info

Female
15 Years Of Experience
Accepts Medicare Assignment
Name
DR. KALLIE LOUISE HARRISON (M.D.)
NPI
1104118249
Phone
(618) 257-4644
Address
4500 MEMORIAL DRIVE
Enumeration Date
9 May 2011
Last Update Date
16 July 2021

Doctor Profile

Medical School Name
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3142516092
Graduation Year
2011 (15 years ago)
PAC ID
0345553160
Group Practice PAC ID
2466699814
Professional Enrollment ID
I20210602003085
Address ID
MO631418232ST621XXRDXX500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience68
Completeness75
Years active:15State licenses:2Digital endpointsOther names

1,923 OBSTETRICS/GYNECOLOGY in IL

Provider Addresses for DR. KALLIE LOUISE HARRISON (M.D.)

  • 4500 MEMORIAL DRIVE

    BELLEVILLE, IL 62226

    Phone: (618) 257-4644

    Fax: (618) 257-6946

    Type: Mailing

  • 4600 MEMORIAL DR STE 400

    BELLEVILLE, IL 622265366

    Phone: (618) 234-2390

    Fax: (618) 234-9936

    Type: Location

  • 615 S NEW BALLAS RD STE 1400

    SAINT LOUIS, MO 631418221

    Phone: (314) 251-7498

    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: 2021-06-02

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210602003085IObstetrics/GynecologyMOTBD

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.

Verify on CMS Revalidation Lookup Tool

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 62226)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466699814View full group profile
NameSpecialtyState
-MO
Certified Nurse Midwife (Cnm)MO
O B S T E T R I C S/ G Y N E C O L O G YMO
O B S T E T R I C S/ G Y N E C O L O G YMO
O B S T E T R I C S/ G Y N E C O L O G YMO
O B S T E T R I C S/ G Y N E C O L O G YMO
-IA
O B S T E T R I C S/ G Y N E C O L O G YIL
O B S T E T R I C S/ G Y N E C O L O G YMO
O B S T E T R I C S/ G Y N E C O L O G YMO

Reviews

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Frequently asked questions

What NPI should I save for DR. KALLIE LOUISE HARRISON (M.D.)?
Save NPI 1104118249 if you need a stable reference for DR. KALLIE LOUISE HARRISON (M.D.).
Is DR. KALLIE LOUISE HARRISON (M.D.)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does DR. KALLIE LOUISE HARRISON (M.D.) treat or focus on?
Patients typically see DR. KALLIE LOUISE HARRISON (M.D.) under the specialty Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
Where does public data place DR. KALLIE LOUISE HARRISON (M.D.)?
The snapshot lists Belleville, Illinois for DR. KALLIE LOUISE HARRISON (M.D.); download NPPES for the complete set.
How can I contact DR. KALLIE LOUISE HARRISON (M.D.)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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