Individual provider Active NPI

Kelly Murphy Olmstead, PH.D.

  • Clinical Psychologist
  • Georgetown, TX
National Provider Identifier
1588769616
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
24080 Issued in TX
Practice address
903 Forest St
Georgetown, TX 78626-5523
Phone
(512) 930-0884
Fax
(512) 931-9413
NPI assigned
Sep 13, 2006
Last updated
Jun 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 24080 TX
Clinical Psychologist 103TC0700X 24080 TX Primary

Addresses

Primary practice location

903 Forest St
Georgetown, TX 78626-5523

Mailing address

903 Forest St
Georgetown, TX 78626-5523
Phone (512) 930-0884

Other identifiers 1

IdentifierTypeStateIssuer
035231201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060307000146 TX Practitioner - Clinical Psychologist 7810903499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Behavioral Health ConsultantsGroup PAC ID 9739086091, 6 clinicians

Practice addresses (Care Compare)

11211 Taylor Draper LN
Suite 202
Austin, TX 78759-3971
Phone (512) 343-8850

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.89 of 100Reported as group
Quality
80
Improvement activities
40
Cost
72.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
24080TXMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Consultants Psychologist CurrentSince Sep 1, 2013 Accepting new patients
Rebecca Burgman LLC PastSince Jul 21, 2020 Accepting new patients
Rebecca Burgman PastSince Aug 23, 2020 Accepting new patients

Locations

11211 Taylor Draper Ln
Ste 202
Austin, TX 78759
Phone (512) 343-8850

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1588769616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 FOREST ST",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265523",
            "telephone_number": "512-930-0884",
            "fax_number": "512-931-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 FOREST ST",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265523",
            "telephone_number": "512-930-0884",
            "fax_number": "512-931-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLMSTEAD",
        "first_name": "KELLY",
        "middle_name": "MURPHY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "24080",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "24080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035231201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.