Martrell Denise Kelly John, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10326 Issued in SC

Practice address

250 Commonwealth Dr
Greenville, SC 29615-4846

Phone

(240) 463-7794

NPI assigned

Sep 27, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Group practices

Regenesis Organization Community Health CenterGroup PAC ID 8022928001, 35 clinicians

Innovation Counseling ServicesGroup PAC ID 9830515535, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles (7 of 10)

Locations

Networks

• devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
• devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
• devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

• Direct secure messaging: martrell.kellyjohn@myrhc.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innovation Counseling Services

  • Community/Behavioral Health Agency
  • Greer, SC
  • NPI 1457993123

  SC

  Medicare reassignment Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
  • NPI 1194710426

  SC

  Medicare reassignment Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
  • NPI 1457745952

  SC

  Medicare reassignment Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
  • NPI 1548528714

  SC

  Medicare reassignment Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Union, SC
  • NPI 1982248852

  SC

  Medicare reassignment Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
  • NPI 1457061087
  Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
  • NPI 1558946376
  Care Compare group NPD
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Duncan, SC
  • NPI 1225899594
  Care Compare group
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Gaffney, SC
  • NPI 1245409846
  Care Compare group
• Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Woodruff, SC
  • NPI 1265777908
  Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1003467267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 HARMONY DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015729",
            "telephone_number": "240-463-7794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 COMMONWEALTH DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154846",
            "telephone_number": "240-463-7794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY JOHN",
        "first_name": "MARTRELL",
        "middle_name": "DENISE",
        "credential": "LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "10326",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14582",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weston Keller, M.D.
• Barto Paul Kellett, MD
• Michael Parris Kellett, M.D.
• Erin Culhan Kelley, LMFT
• Katelyn Mae Kelley, PA-C
• Kelly Ultrasound Center LLC
• Christopher Lee Kelly, PA-C
• Debbie S Kelly, CRNA
• Desmond Peyton Kelly, M.D.
• John William Kelly, M.D.

• All providers in Greenville, SC
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.