NPIMap

Individual provider Active NPI

Kellie Clayton Bagi, CRNP

  • Nurse Practitioner
  • Montgomery, AL
National Provider Identifier
1093368631
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1-148539 Issued in AL
Practice address
2065 E South Blvd Ste 201
Montgomery, AL 36116-2460
Phone
(334) 747-7250
Fax
(334) 747-7270
NPI assigned
Jul 23, 2019
Last updated
Jan 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-148539 AL Primary

Addresses

Primary practice location

2065 E South Blvd Ste 201
Montgomery, AL 36116-2460

Mailing address

301 Brown Springs Rd
Montgomery, AL 36117-7005
Phone (334) 747-4159

Other practice location 1

1315 Mulberry St
Montgomery, AL 36106-1132
Phone (334) 262-1113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200803002890 AL Practitioner - Nurse Practitioner 5597180851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Alabama School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2065 E S Blvd
Suite 201
Montgomery, AL 36116-2460
Phone (334) 747-7250

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83 of 100Reported as group
Quality
64.43
Promoting interoperability
100
Improvement activities
40
Cost
78.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-148539ALMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs Neurology CurrentSince Mar 30, 2020 Accepting new patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs CurrentSince Mar 30, 2020 Accepting new patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs Current Accepting new patients
The Health Care Authority for Baptist Health Past Accepting new patients
Neurological Care Center of Montgomery PC Neurology PastSince Jul 28, 2019 Accepting new patients
The Health Care Authority for Baptist Health an Affiliate of Uabhs Past Accepting new patients
The Health Care Authority for Baptist Health Past Accepting new patients

Locations

2055 E South Blvd
Ste 200
Montgomery, AL 36116
Phone (334) 284-5211

2055 E South Blvd
Ste 308
Montgomery, AL 36116
Phone (334) 286-2390

2065 E South Blvd
Ste 201
Montgomery, AL 36116
Phone (334) 281-9172

2065 E South Blvd
Ste 301
Montgomery, AL 36116
Phone (334) 747-7250

301 Brown Springs Rd
Montgomery, AL 36117
Phone (334) 273-4159

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1093368631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BROWN SPRINGS RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361177005",
            "telephone_number": "334-747-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 E SOUTH BLVD STE 201",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162460",
            "telephone_number": "334-747-7250",
            "fax_number": "334-747-7270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 Mulberry St",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361061132",
            "country_code": "US",
            "telephone_number": "334-262-1113",
            "fax_number": "334-262-1119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGI",
        "first_name": "KELLIE",
        "middle_name": "CLAYTON",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-148539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.