Individual provider Active NPI

Kelli Ann Conlon

  • Clinical Social Worker
  • Lafayette, IN
National Provider Identifier
1255846697
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34008011A Issued in IN
Practice address
1116 N 16TH St
Lafayette, IN 47904-2119
Phone
(765) 423-6300
Fax
(765) 423-6301
NPI assigned
Dec 7, 2017
Last updated
Jan 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34008011A IN Primary

Addresses

Primary practice location

1116 N 16TH St
Lafayette, IN 47904-2119

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kconlon408741@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171214001409 IN Practitioner - Clinical Social Worker 4688932999 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

1116 N 16TH St
Lafayette, IN 47904-2119
Phone (765) 428-5850

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34008011AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Oaks Health Inc CurrentSince Nov 29, 2017 Accepting new patients
Franciscan Physician Network CurrentSince Mar 4, 2019 Accepting new patients
Valley Oaks Health Inc CurrentSince Nov 29, 2017 Accepting new patients
Franciscan Physician Network CurrentSince Mar 4, 2019 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1265 N Bradford Dr
Delphi, IN 46923
Phone (765) 564-2247

1040 Sierra Dr
Ste 400
Greenwood, IN 46143
Phone (317) 528-4886

1116 N 16th St
Lafayette, IN 47904
Phone (765) 423-6300

415 N 26th St
Ste 201
Lafayette, IN 47904
Phone (765) 446-6535

610 Main St
Lafayette, IN 47901
Phone (765) 423-2638

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Interoperability endpoints

  • Direct secure messaging: kconlon408741@direct.franciscanalliance.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1255846697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 N 16TH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042119",
            "telephone_number": "765-423-6300",
            "fax_number": "765-423-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONLON",
        "first_name": "KELLI",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34008011A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kconlon408741@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1116 N 16th St",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479042119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.