Camille Marie Kielbasa, APRN, AGCNS-BC

Primary specialty

Gerontology Clinical Nurse SpecialistTaxonomy code 364SG0600X

License

1003698 Issued in TX

Practice address

4945 Williams Dr
Georgetown, TX 78633-2008

Phone

(512) 819-0500

NPI assigned

Jul 21, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

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 2

Specialty

Certified Clinical Nurse Specialist (CNS)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Medical Center - Round Rock Hospital, Round Rock, TX, CCN 670034

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckielbasa1350159@direct.sw.org

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.

• Scott & White Clinic

  • Internal Medicine Physician
  • Temple, TX
  • NPI 1093779704
  Medicare reassignment Care Compare group NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1649820796
  NPD
• Aco Jason Martin Medical Consulting

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1881578961
  NPD (past)
• Scott & White Hospital - Taylor

  • Emergency Medicine Physician
  • Taylor, TX
  • NPI 1659366557
  NPD (past)

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

• Scott & White Hospital - Round Rock

  • General Acute Care Hospital
  • Round Rock, TX
  • NPI 1265568638
  Care Compare affiliation

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1609501774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "800-994-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4945 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786332008",
            "telephone_number": "512-819-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIELBASA",
        "first_name": "CAMILLE",
        "middle_name": "MARIE",
        "credential": "APRN, AGCNS-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-21",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "TX",
            "license": "1003698",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "TX",
            "license": "1003698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckielbasa1350159@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4945 Williams Dr",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786332008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Khem Labs LLC
• Mohammad Khondkar, RPH
• Lamis Khoury
• Kidabilities PC
• Ben Kiefer
• Sandra L. Kienitz, RN
• Brian T Kim, DDS
• Christine Anne Kimber, COTA
• Kimberly Shewmaker, P.C.
• Amy Marie King

• Gerontology Clinical Nurse Specialist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Gerontology Clinical Nurse Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.