Individual provider Active NPI

Kellie T Shanholtz, CRNA

  • Certified Registered Nurse Anesthetist
  • Winchester, VA
National Provider Identifier
1659347524
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AC002767 Issued in MD
Practice address
1840 Amherst St
Winchester, VA 22601-2808
Phone
(540) 536-8000
Fax
(540) 536-7681
NPI assigned
Feb 28, 2006
Last updated
Jul 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AC002767 MD Primary
Certified Registered Nurse Anesthetist 367500000X 0024134809 VA

Addresses

Primary practice location

1840 Amherst St
Winchester, VA 22601-2808

Mailing address

1840 Amherst St
Winchester, VA 22601-2808
Phone (540) 536-8000

Other identifiers 1

IdentifierTypeStateIssuer
2604151000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, MD, WV, DC4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20050111000661 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941258404 Reassigns benefits to 3 organizations
I20190809001991 MD Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941258404 Reassigns benefits to 1 organization
I20240405000520 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941258404 Reassigns benefits to 3 organizations
I20240416003087 DC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941258404 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City Hospital IncGroup PAC ID 3375444524, 155 clinicians

Practice addresses (Care Compare)

2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone (304) 260-1443

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
63.85 of 100Reported as group
Quality
57.47
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
0024134809VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Winchester Medical Center CurrentSince Jan 7, 2002 Accepting new patients
American Anesthesiology of Virginia, PC CurrentSince Oct 2, 2018 Accepting new patients
Jefferson Memorial Hospital CurrentSince Jun 6, 2024 Accepting new patients
Jefferson Memorial Hospital CurrentSince Jun 6, 2024 Accepting new patients
City Hospital, Inc. CurrentSince May 6, 2024 Accepting new patients
American Anesthesiology of Virginia PC CurrentSince Oct 2, 2018 Accepting new patients
Shenandoah Valley Pathology Laboratories Inc Current Accepting new patients
Winchester Medical Center Current Accepting new patients
Winchester Anesthesiologists Inc CurrentSince Aug 1, 2011 Accepting new patients
First Colonies Anesthesia Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 17, 2019 Accepting new patients
Winchester Medical Center Nurse Anesthetist, Certified Registered CurrentSince Jan 7, 2002 Accepting new patients
Winchester Medical Center Current Accepting new patients
Jefferson Memorial Hospital Current Accepting new patients
City Hospital Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

400 W 7th St
Frederick, MD 21701
Phone (240) 566-3300

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

11210 Old Georgetown Rd
Rockville, MD 20852
Phone (301) 881-7770

1500 Forest Glen Rd
Silver Spring, MD 20910
Phone (301) 754-7230

8322 Bellona Ave
Ste 201
Towson, MD 21204
Phone (410) 337-2688

12222 Merit Dr
Ste 600
Dallas, TX 75251
Phone (972) 776-3185

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

1840 Amherst St
Winchester, VA 22601
Phone (540) 536-8700

1860 Amherst St
Winchester, VA 22601
Phone (540) 536-7870

874 Fox Dr
Winchester, VA 22603
Phone (540) 662-0990

2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134

300 S Preston St
Ranson, WV 25438
Phone (304) 728-1600

Organizations & group practices 15

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.

View all 15

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1659347524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 AMHERST ST",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012808",
            "telephone_number": "540-536-8000",
            "fax_number": "540-536-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 AMHERST ST",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012808",
            "telephone_number": "540-536-8000",
            "fax_number": "540-536-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANHOLTZ",
        "first_name": "KELLIE",
        "middle_name": "T",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "AC002767",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024134809",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2604151000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.