Individual provider Active NPI

Kelli Michele Kamousi, APRN

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1174284400
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2021117665 Issued in KY
Practice address
7926 Preston Hwy Ste 106
Louisville, KY 40219-3848
Phone
(502) 964-4357
Fax
(502) 966-5948
NPI assigned
Jan 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2021117665 KY Primary

Addresses

Primary practice location

7926 Preston Hwy Ste 106
Louisville, KY 40219-3848

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 559-9295

Other identifiers 1

IdentifierTypeStateIssuer
300058863MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkamousi79033@direct.nortonhealthcare.org Direct

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
I20220218002466 KY Practitioner - Nurse Practitioner 5597159467 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
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

7926 Preston Hwy
Suite 106
Louisville, KY 40219-3848
Phone (502) 964-4357

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2021117665KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Mar 1, 2022 Accepting new patients
Community Medical Associates, Inc. Family Current Accepting new patients
Southeastern Emergency Physicians LLC CurrentSince May 9, 2024 Accepting new patients
Community Medical Associates, Inc. CurrentSince Mar 1, 2022 Accepting new patients

Locations

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

12903 Shelbyville Rd
Louisville, KY 40243
Phone (502) 244-5827

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

7926 Preston Hwy
Ste 106
Louisville, KY 40219
Phone (502) 964-4357

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1641600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1174284400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-559-9295",
            "fax_number": "502-272-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7926 PRESTON HWY STE 106",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193848",
            "telephone_number": "502-964-4357",
            "fax_number": "502-966-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMOUSI",
        "first_name": "KELLI",
        "middle_name": "MICHELE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-08",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "2021117665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300058863",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkamousi79033@direct.nortonhealthcare.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7926 Preston Hwy Ste 106",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402193848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.