Individual provider Active NPI

Kelly Addy, NP

  • Family Nurse Practitioner
  • Greenwood, SC
National Provider Identifier
1790215291
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
21065 Issued in SC
Practice address
1325 Spring St
Greenwood, SC 29646-3860
Phone
(864) 725-4111
NPI assigned
Jun 16, 2017
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 21065 SC Primary

Addresses

Primary practice location

1325 Spring St
Greenwood, SC 29646-3860

Mailing address

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kaddy159188@selfregional.direct-ci.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170727004149 SC Practitioner - Nurse Practitioner 2163792813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
21065SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Jun 16, 2017 Accepting new patients
Self Medical Group CurrentSince Jun 16, 2017 Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6875
Chicago, IL 60675

102 Rockcreek Blvd
Greenwood, SC 29649
Phone (864) 725-5020

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

22580 Highway 76 E
Ste 300
Laurens, SC 29360
Phone (864) 725-4183

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: kaddy159188@selfregional.direct-ci.net

Organizations & group practices 5

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": "1497571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1790215291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDY",
        "first_name": "KELLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-16",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kaddy159188@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "1325 Spring St",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296463860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.