Shannon Cathleen Kelly, APN
Individual provider Active NPI Acute Care Nurse Practitioner · Toms River, NJ
NPI 1093469744 · NPPES record last updated Feb 11, 2022
Key facts
- NPI
- 1093469744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- 26NR01268700 (NJ)
- Practice address
- 601 Route 37 W Ste 104
Toms River, NJ 08755-8050 - Phone
- (732) 240-1100
- NPI assigned
- Feb 10, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Change of Heart Cardiology LLC
Practice addresses (Care Compare)
2130 Hwy 35
Suite 321C
Sea Girt, NJ 08750-1011
Phone (732) 974-6700
Hospital & facility affiliations
- Centrastate Medical Center
- Jersey Shore University Medical Center
- JFK University Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.85 of 100
- Quality
- 86.16
- Improvement activities
- 40
- Cost
- 81.27
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.79 of 100
- Quality
- 98.99
- Improvement activities
- 40
- Cost
- 70.64
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220407000023 | NJ | Practitioner - Nurse Practitioner | 2567858111 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NR01268700 | NJ | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ocean Primary Care LLC | Current |
Accepting new patients | |
| Ocean Physicians LLC | Current |
Accepting new patients | |
| Change of Heart Cardiology, LLC | Current |
Accepting new patients |
Locations
2130 Highway 35
Ste 325C
Sea Girt, NJ 08750
2130 Highway 35
Ste 321
Sea Girt, NJ 08750
Phone (732) 974-6700
2130 Highway 35
Ste 325
Sea Girt, NJ 08750
2130 Highway 35
Ste 321C
Sea Girt, NJ 08750
601 Route 37 W
Ste 104
Toms River, NJ 08755
Phone (732) 240-1100
Interoperability endpoints
- shannon.kelly@changeofheartcardiology.chartmakerdirect.com
- skelly@chc.azalea.phimailbox.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 26NR01268700 | NJ | Yes |
Addresses
Primary practice location
601 Route 37 W Ste 104
Toms River, NJ 08755-8050
Mailing address
601 Rte 37 W Ste 104
Toms River, NJ 08755-8050
Phone (732) 240-1100
Other providers in Toms River, NJ
- Tabetha Tapiwa-Rose Keita
- Tyler E Keller
- Melanie Rose Kellner
- Audrey Leah Kelly
- Riva Kelly
- Tara Kelly
- Alyssa Kelman
- Avigail Kemmoun
- Trina Kennedy-Harjes
- Beth Anne Kennedy
All providers in Toms River, NJ · Acute Care Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.