Kelly C O'Heron, RD CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1939 Issued in WI

Practice address

1515 Park Ave
Columbus, WI 53925-2402

Phone

(920) 623-2200

NPI assigned

Jul 26, 2006

Reactivated

Feb 21, 2023

Last updated

Mar 3, 2025By the provider in NPPES

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 WI

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prairie Ridge Health IncGroup PAC ID 6800791484, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Columbus Community Hospital Hospital, Columbus, WI, CCN 521338

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/

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.

• Prairie Ridge Health, Inc.

  • Critical Access Hospital
  • Columbus, WI
  • NPI 1154403657
  Medicare reassignment Care Compare group NPD
• Prairie Ridge Health Inc.

  dba Prairie Ridge Health Clinic-Sun Prairie

  • Family Medicine Physician
  • Sun Prairie, WI
  • NPI 1699534545
  NPD
• Prairie Ridge Health, Inc.

  • Orthopaedic Surgery Physician
  • Columbus, WI
  • NPI 1912329335
  NPD
• Prairie Ridge Health, Inc.

  • Orthopaedic Surgery Physician
  • Beaver Dam, WI
  • NPI 1093137416
  NPD (past)

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

• Prairie Ridge Health, Inc.

  • Critical Access Hospital
  • Columbus, WI
  • NPI 1154403657
  Care Compare affiliation
• Prairie Ridge Health, Inc.

  • Critical Access Hospital
  • Columbus, WI
  • NPI 1841376183
  Care Compare affiliation
• Prairie Ridge Health, Inc.

  • Orthopaedic Surgery Physician
  • Columbus, WI
  • NPI 1912329335

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1326062415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "WI",
            "postal_code": "53925",
            "country_code": "US",
            "telephone_number": "920-623-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'HERON",
        "first_name": "KELLY",
        "middle_name": "C",
        "credential": "RD CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "deactivation_date": "2017-10-25",
        "reactivation_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "1939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "490905189007",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Mitchell, MD
• Valerie Monthie, RN ,WCC
• Emily Rebecca Moore, MS, RD, CD, CSO
• Matthew C Niesen, M.D.
• Andrew Nothem, D.D.S.
• Dennis A Oeth, MD
• Debbie Oldenburg, D.C.
• Marisa Renee Opsahl, R.N.
• Osl 550 Columbus Operating LLC
• Mitchell Osterhaus, RN

• Registered Dietitian in Columbus, WI
• Providers in Columbus, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.