Nicole Shawntay Kelly, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP211493 Issued in ME

Practice address

300 Main St
Lewiston, ME 04240-7041

Phone

(207) 795-0111

NPI assigned

Oct 10, 2021

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

Medicare fee-for-service enrollment

Enrolled in ME

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Central Maine Medical CenterGroup PAC ID 2567379563, 344 clinicians

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Maine Medical Center Hospital, Lewiston, ME, CCN 200024
• Bridgton Hospital Hospital, Bridgton, ME, CCN 201310

Merit-based Incentive Payment System (MIPS)

Final score

85.02 of 100Reported as group

Quality

59.99

Promoting interoperability

99

Improvement activities

40

Cost

74.25

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

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.

• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Medicare reassignment Care Compare group NPD
• Central Maine Medical Center

  • Community/Retail Pharmacy
  • Lewiston, ME
  • NPI 1033874458
  NPD
• Central Maine Medical Center

  • Multi-Specialty Clinic/Center
  • Manchester, ME
  • NPI 1598411175
  NPD

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

• Bridgton Hospital

  • Critical Access Hospital
  • Bridgton, ME
  • NPI 1154370153
  Care Compare affiliation
• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Care Compare affiliation

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

{
    "created_epoch": "1633824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633824000000",
    "number": "1114689817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 LAURIER ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042404106",
            "telephone_number": "207-332-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407041",
            "telephone_number": "207-795-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICOLE",
        "middle_name": "SHAWNTAY",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-10",
        "last_updated": "2021-10-10",
        "certification_date": "2021-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP211493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANP",
            "identifier": "F09210797",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie M Keller, OTR/L
• Sokharath Keller, FNP-BC
• Shana Juliet Kelley-Cohen, LCSW
• Michael E Kelley, MD
• Nancy Anne Kelliher, OCCUPATIONAL THERAPI
• Timothy Kelly, PA-C
• Lisa M Kelsen, FNP-BC
• Sally Jo Holt Kelsey, REGISTERED NURSE
• Katherine A Kemp
• Roberta Kemper

• Family Nurse Practitioner in Lewiston, ME
• Providers in Lewiston, ME by specialty
• Family Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2021; 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.