NPIMap

Individual provider Active NPI

Kelly Douglass, CRNP

  • Nurse Practitioner
  • Williamsport, PA
National Provider Identifier
1598198525
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP013049 Issued in PA
Practice address
1705 Warren Ave
Suite 303
Williamsport, PA 17701-2665
Phone
(570) 326-8500
Fax
(570) 326-8049
NPI assigned
Aug 13, 2013
Last updated
Aug 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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 SP013049 PA Primary

Addresses

Primary practice location

1705 Warren Ave
Suite 303
Williamsport, PA 17701-2665

Mailing address

1201 Grampian Blvd
Suite 1K
Williamsport, PA 17701-1900

Other names 1

  • Miss Kelly Jamison Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20131231000204 PA Practitioner - Nurse Practitioner 4082841762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1205 Grampian Blvd
Suite 3C
Williamsport, PA 17701-1970
Phone (570) 320-7800

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Jun 1, 2020 Accepting new patients
Susquehanna Physician Services Nurse Practitioner Past Accepting new patients

Locations

900 Plaza Dr
#F
Montoursville, PA 17754
Phone (570) 601-8574

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

1201 Grampian Blvd
Ste 1K
Williamsport, PA 17701

1205 Grampian Blvd
Ste 3C
Williamsport, PA 17701
Phone (570) 320-7800

Interoperability endpoints

  • Direct secure messaging: kdouglass79046@upmc.direct-ci.com
  • Direct secure messaging: kelly.d.douglass@upmcdirect.com

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1598198525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "address_2": "SUITE 1K",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 WARREN AVE",
            "address_2": "SUITE 303",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012665",
            "telephone_number": "570-326-8500",
            "fax_number": "570-326-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP013049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JAMISON",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.