Kelli Ann Gillott, MSN CRNP

Key facts

NPI

1346200375

Entity type

Individual (NPI type 1)

Primary specialty

Nurse Practitioner 363L00000X

License

SP006394B (PA)

Practice address

22 Mill Street
Uniontown, PA 15401

Phone

(724) 437-1582

Fax

(724) 437-1571

NPI assigned

Mar 24, 2006

Sex

Female

Sole proprietor

Yes

Organizations & group practices 5

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.

• Adagio Health Inc. Non-Surgical Family Planning Clinic/Center · Aliquippa, PA · NPI 1295826022
  Medicare reassignment Care Compare group NPD NURSE PRACTITIONER · PA
• Adagio Health Inc. Non-Surgical Family Planning Clinic/Center · Pittsburgh, PA · NPI 1487877023
  Care Compare group NPD
• Adagio Health Inc. Non-Surgical Family Planning Clinic/Center · Sharon, PA · NPI 1609219161
  NPD
• Adagio Health Inc. Non-Surgical Family Planning Clinic/Center · Uniontown, PA · NPI 1558455675
  NPD (past) NURSE PRACTITIONER
• Windber Hospital, Inc. General Acute Care Hospital · Windber, PA · NPI 1275620536
  NPD (past)

Hospital & facility affiliations 5

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

• Uniontown Hospital Clinic/Center · Uniontown, PA · NPI 1225045131
  Care Compare affiliation Hospital
• Uniontown Hospital Internal Medicine Physician · Uniontown, PA · NPI 1245488048
  Care Compare affiliation Hospital
• Uniontown Hospital Institutional Pharmacy · Uniontown, PA · NPI 1801910989
  Care Compare affiliation Hospital
• Uniontown Hospital General Acute Care Hospital · Uniontown, PA · NPI 1861409773
  Care Compare affiliation Hospital
• Uniontown Hospital General Acute Care Hospital · Uniontown, PA · NPI 1871594127
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Adagio Health Inc. (16 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uniontown Hospital Hospital · Uniontown, PA · CCN 390041

Medicare participation

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelli.gillott@direct.adagiohealth.nextgenshare.com

Specialties & licenses

Addresses

Other identifiers

Other names

• Miss Kelli Ann Koballa Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 27, 2015.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432684800000",
    "number": "1346200375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MILL STREET",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "15401",
            "telephone_number": "724-437-1582",
            "fax_number": "724-437-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MILL STREET",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "15401",
            "telephone_number": "724-437-1582",
            "fax_number": "724-437-1571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLOTT",
        "first_name": "KELLI",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MSN CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2015-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN512040L",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP006394B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1991407",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "GI1324550",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "KOBALLA",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "MSN CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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