Active NPI
Jennifer Elisabet Kelly, PSY.D.
- Cognitive & Behavioral Psychologist
- Portland, OR
National Provider Identifier
1730464157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- Practice address
- 833 SW 11TH Ave
Ste 245
Portland, OR 97205-2132 - Phone
- (971) 248-5050
- NPI assigned
- Oct 17, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | Primary |
Addresses
Primary practice location
833 SW 11TH Ave
Ste 245
Portland, OR 97205-2132
Mailing address
833 SW 11TH Ave
Ste 245
Portland, OR 97205-2132
Phone (971) 248-5050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140107000878 | OR | Practitioner - Clinical Psychologist | 7911135488 | Practice locations: Portland, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5331 S Macadam Ave
Suite 258 436
Portland, OR 97239-6104
Phone (971) 248-5050
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495497600000",
"number": "1730464157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 SW 11TH AVE",
"address_2": "STE 245",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052132",
"telephone_number": "971-248-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "833 SW 11TH AVE",
"address_2": "STE 245",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052132",
"telephone_number": "971-248-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JENNIFER",
"middle_name": "ELISABET",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-17",
"last_updated": "2017-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2017; 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.