NPIMap

Individual provider Active NPI

Maria Kelley, NP

  • Gerontology Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1326597683
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APN.0992709-NP Issued in CO
Practice address
2121 E Harmony Rd Unit 100
Fort Collins, CO 80528-3401
Phone
(970) 221-1000
Fax
(970) 297-6844
NPI assigned
Sep 28, 2016
Last updated
Nov 7, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0992709-NP CO
Gerontology Nurse Practitioner 363LG0600X APN.0992709-NP CO Primary
Registered Nurse 163W00000X 0198115 CO

Addresses

Primary practice location

2121 E Harmony Rd Unit 100
Fort Collins, CO 80528-3401

Mailing address

2121 E Harmony Rd Unit 100
Fort Collins, CO 80528-3401
Phone (970) 221-1000

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidCO

Other names 1

  • Maria Johll Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161214000161 CO Practitioner - Nurse Practitioner 8325328115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

11083 Colorado Blvd
Firestone, CO 80504-5873
Phone (303) 833-8880

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

2121 E Harmony Rd
Fort Collins, CO 80528-3413

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0198115COMDRegistered Nurse
APN.0992709-NPCOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Dec 3, 2016 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Dec 3, 2016 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

1107 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 493-7442

2121 E Harmony Rd
Unit 100
Fort Collins, CO 80528
Phone (970) 663-3107

2121 E Harmony Rd
Unit 160
Fort Collins, CO 80528
Phone (970) 482-3328

2500 Rocky Mountain Ave
Ste 100
Loveland, CO 80538
Phone (970) 624-1800

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

Organizations & group practices 2

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1326597683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283401",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283401",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0992709-NP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "APN.0992709-NP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "0198115",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "JOHLL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.