Individual provider Active NPI

Shelby Maureen Klingensmith, APRN-CNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Covington, KY
National Provider Identifier
1104561273
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
3017710 Issued in KY
Practice address
1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone
(859) 301-5901
Fax
(859) 301-5940
NPI assigned
May 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3017710 KY Primary

Addresses

Primary practice location

1500 James Simpson Jr Way
Covington, KY 41011-0801

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-5901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20220609001274 KY Practitioner - Nurse Practitioner 2668850280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone (859) 655-8910

Hospital & facility affiliations

  • St Elizabeth Edgewood Hospital, Edgewood, KY, CCN 180035

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3017710KYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Kentucky Mental Health Mental Retardation Regional Board CurrentSince May 9, 2022 Accepting new patients
Northern Kentucky Mental Health Mental Retardation Regional Board CurrentSince May 9, 2022 Accepting new patients
Summit Medical Group, Inc Psychiatric/Mental Health CurrentSince Aug 30, 2024 Accepting new patients
Summit Medical Group, Inc. CurrentSince Aug 30, 2024 Accepting new patients
Summit Medical Group, Inc Current Accepting new patients

Locations

1500 James Simpson Jr Way
Covington, KY 41011
Phone (859) 655-4353

503 Farrell Dr
Covington, KY 41011
Phone (606) 578-3214

513 Madison Ave
Fl 4
Covington, KY 41011

7459 Burlington Pike
Florence, KY 41042
Phone (859) 282-6585

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1651536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1104561273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 JAMES SIMPSON JR WAY",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410110801",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINGENSMITH",
        "first_name": "SHELBY",
        "middle_name": "MAUREEN",
        "credential": "APRN-CNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-03",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3017710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, KY

Sources for this page

Verify at the official NPI Registry.