Kelly A Anderson, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71003789A Issued in IN

Practice address

7900 W Jefferson Blvd
Suite 304
Fort Wayne, IN 46804-4128

Phone

(260) 969-6200

Fax

(260) 969-6201

NPI assigned

Sep 15, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly A Brickley Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kingston Care Partners, LLCGroup PAC ID 1850589102, 11 clinicians

Trilogy NP, LLCGroup PAC ID 5092290411, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Indiana University Health Hospital, Indianapolis, IN, CCN 150056

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Kingston Care Partners, LLC

  • Nursing Care Agency
  • Toledo, OH
  • NPI 1609185180

  IN

  Medicare reassignment Care Compare group NPD
• Trilogy NP, LLC

  • Nursing Care Agency
  • Louisville, KY
  • NPI 1740159151

  IN

  Medicare reassignment Care Compare group
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indiana University Health Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024
  Care Compare affiliation
• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326412800000",
    "number": "1043592033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8857",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468988857",
            "telephone_number": "260-969-6200",
            "fax_number": "260-969-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD",
            "address_2": "SUITE 304",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-969-6200",
            "fax_number": "260-969-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2012-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71003789A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201040960",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BRICKLEY",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Lee Anderson
• Holli Anderson
• Janet Baker Anderson, RN FNP
• Jeremy Anderson
• Jessica Renae Anderson, RN
• Lindsey Rose Anderson, LCSW
• Lizbeth Ann Anderson, M.S., BCBA
• Madion Anderson, RBT
• Margaret Mary Anderson
• Matthew Anderson, MSW

• Adult Health Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.