Kelly Ann Godberson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

308240 Issued in NY

Practice address

3115 Horseblock Rd
Medford, NY 11763-2526

Phone

(631) 730-3000

NPI assigned

Jul 12, 2017

Last updated

Jul 12, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

25 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

83.33

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kag Professional Nurse Practitioner in Adult Health PLLC

  • Adult Health Nurse Practitioner
  • Medford, NY
  • NPI 1295391985
  Medicare reassignment NPD Authorized official
• NK Medical PC

  • Nephrology Physician
  • Shirley, NY
  • NPI 1467873018
  Medicare reassignment NPD
• Suffolk Medical Specialist, PLLC

  • Internal Medicine Physician
  • Port Jefferson Station, NY
  • NPI 1710950688
  Medicare reassignment NPD

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499817600000",
    "number": "1053833962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MARLIN RD",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117203012",
            "telephone_number": "631-698-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 HORSEBLOCK RD",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632526",
            "telephone_number": "631-730-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODBERSON",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "308240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTIONER LICENSE",
            "identifier": "308240",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudio Ginebra, RPA-C
• Michelle Giordano
• Rahul Gladwin, MD
• Samantha Gleeson, RN
• Gloria B. Donaii
• Jessica A Golden, LMSW
• Todd Russell Goldman, D.C.
• Lester Allan Goldschmidt, MS, RPH
• Scott Louis Goldstein, DDS
• Erik Brian Gonzalez, D.D.S.

• Nurse Practitioner in Medford, NY
• Providers in Medford, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; 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.