Individual provider Active NPI

Kelli Renee Pound, FNP

  • Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1356113146
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704252441 Issued in MI
Practice address
2490 S 11TH St
Kalamazoo, MI 49009-2175
Phone
(269) 343-1535
NPI assigned
Oct 25, 2023
Last updated
Oct 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704252441 MI Primary

Addresses

Primary practice location

2490 S 11TH St
Kalamazoo, MI 49009-2175

Mailing address

3126 Lost Pine Way
Portage, MI 49024-8407
Phone (248) 890-2201

Other names 1

  • Kelli Renee Bethuram Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20231205000717 MI Practitioner - Nurse Practitioner 7719335579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

2490 S 11TH St
Suite 201
Kalamazoo, MI 49009-2175
Phone (269) 343-1535

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Nov 16, 2023 Accepting new patients
Beacon Medical Group Michigan Inc Current Accepting new patients
Beacon Medical Group Michigan Inc CurrentSince Nov 16, 2023 Accepting new patients

Locations

1701 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-2550

1717 Shaffer St
Ste 2
Kalamazoo, MI 49048

2490 S 11th St
Ste 201
Kalamazoo, MI 49009
Phone (269) 343-1535

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Organizations & group practices 3

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1356113146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 LOST PINE WAY",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490248407",
            "telephone_number": "248-890-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 S 11TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490092175",
            "telephone_number": "269-343-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POUND",
        "first_name": "KELLI",
        "middle_name": "RENEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-25",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704252441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "BETHURAM",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.