Nickelle Anne Kellough, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC3480 Issued in FL

Practice address

300 S Park Rd Ste 300
Hollywood, FL 33021-8353

Phone

(954) 925-2740

Fax

(954) 923-8379

NPI assigned

Jun 23, 2009

Sex

Female

Sole proprietor

Yes

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.79 of 100Reported as group

Quality

64.42

Promoting interoperability

100

Improvement activities

40

Cost

74.88

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nickelle.kellough.1@9109.direct.athenahealth.com

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.

• North Florida Surgeons, PA

  • Surgery Physician
  • Jacksonville, FL
  • NPI 1912953290
  Medicare reassignment Care Compare group NPD
• Dr. Ted Brink and Associates PA

  • Optometrist
  • Jacksonville, FL
  • NPI 1427138650
  Medicare reassignment NPD
• Dr.Ted Brink & Associates

  • Optometrist
  • Jacksonville, FL
  • NPI 1730402686
  NPD
• North Florida Surgeons, PA

  • Orthopaedic Surgery Physician
  • Gulf Breeze, FL
  • NPI 1871442053
  NPD

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1669600102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S PARK RD STE 300",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218353",
            "telephone_number": "954-925-2740",
            "fax_number": "954-923-8379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S PARK RD STE 300",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218353",
            "telephone_number": "954-925-2740",
            "fax_number": "954-923-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOUGH",
        "first_name": "NICKELLE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-23",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Keller, LMHC
• Amy Catherine Kelley, M.S. OT
• Devin Kelley, APRN
• Norah J.M. Kelley, APRN
• Paula Kellman-Marsh
• Askari Imani Kelly
• Laquinta Kelly
• Rachael Kelly
• Stacey Kelly
• Kimberly Denise Kelsey, NURSE PRACTITIONER

• Optometrist in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; 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.