Michele Ann Kelly, CPNP NPP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

F380749 Issued in NY

Practice address

153 Lake Shore Rd
Phoenix House Medical Dept
Ronkonkoma, NY 11779

Phone

(631) 471-5666

NPI assigned

Dec 27, 2006

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

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989

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.

• Nurse Practitioner Infant and Child Healthcare, PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Jefferson, NY
  • NPI 1568958700
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457416737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "11764",
            "telephone_number": "631-331-0511",
            "fax_number": "631-444-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 LAKE SHORE RD",
            "address_2": "PHOENIX HOUSE MEDICAL DEPT",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "11779",
            "telephone_number": "631-471-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHELE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "CPNP NPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F380749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaclyn Kateridge
• Danielle Keenan
• Scott Keller, DC
• Erin Elizabeth Kelly
• Jennifer Eileen Kelly
• Kelle M Kenzik, LCSW
• George Kerrigan
• Alexander John Ketterer
• Ayesha Khatri
• June Kiefer, MSN CS NPP

• Nurse Practitioner in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.