Individual provider Active NPI

Kelly A. Roughgarden, LPC

  • Professional Counselor
  • Moosic, PA
National Provider Identifier
1750949384
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
340 Montage Mountain Rd
Moosic, PA 18507-1707
Phone
(570) 346-3686
NPI assigned
May 29, 2019
Last updated
May 29, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X PA Primary

Addresses

Primary practice location

340 Montage Mountain Rd
Moosic, PA 18507-1707

Mailing address

1535 Quincy Ave
Dunmore, PA 18509-2503
Phone (570) 498-3129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241125000033 PA Practitioner - Mental Health Counselor 3870028103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Matthew a Berger MD PCGroup PAC ID 5991791212, 51 clinicians

Practice addresses (Care Compare)

340 Montage Mountain Rd
Moosic, PA 18507-1707
Phone (570) 346-3686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Matthew a Berger MD PC CurrentSince Nov 6, 2024 Accepting new patients

Locations

340 Montage Mountain Rd
Moosic, PA 18507
Phone (570) 344-9266

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1750949384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 QUINCY AVE",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185092503",
            "telephone_number": "570-498-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MONTAGE MOUNTAIN RD",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071707",
            "telephone_number": "570-346-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGHGARDEN",
        "first_name": "KELLY",
        "middle_name": "A.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moosic, PA

Sources for this page

Verify at the official NPI Registry.