NPIMap

Individual provider Active NPI

Shauna Rae Walter Kelly, DO

  • Family Medicine Physician
  • Aurora, CO
National Provider Identifier
1811550015
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0066199 Issued in CO
Practice address
1411 S Potomac St Ste 300
Aurora, CO 80012-4539
Phone
(303) 531-4910
NPI assigned
Apr 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CO
Family Medicine Physician 207Q00000X DR.0066199 CO Primary

Addresses

Primary practice location

1411 S Potomac St Ste 300
Aurora, CO 80012-4539

Mailing address

1411 S Potomac St Ste 300
Aurora, CO 80012-4539
Phone (303) 531-4910

Other identifiers 1

IdentifierTypeStateIssuer
T63857929OtherVADRIVER'S LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address srkelly@vcom.vt.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220420003200 CO Practitioner - Family Practice 8729475702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15901 E Briarwood Cir
200 CSNH Primary Care
Aurora, CO 80016-1785
Phone (303) 269-2626

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
78.58
Promoting interoperability
100
Improvement activities
40
Cost
74.61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DR.0066199COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Portercare Adventist Health System Current Accepting new patients
Portercare Adventist Health System Family Medicine CurrentSince Jun 1, 2022 Accepting new patients
Portercare Adventist Health System CurrentSince Jun 1, 2022 Accepting new patients
Portercare Adventist Health System Past Accepting new patients

Locations

15901 E Briarwood Cir
Unit 200
Aurora, CO 80016
Phone (303) 269-2626

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

7750 S Broadway
Ste 260
Littleton, CO 80122
Phone (303) 734-8650

Interoperability endpoints

  • Direct secure messaging: skelly1870505@adventhealth.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1811550015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 S POTOMAC ST STE 300",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124539",
            "telephone_number": "303-531-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 S POTOMAC ST STE 300",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124539",
            "telephone_number": "303-531-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHAUNA",
        "middle_name": "RAE WALTER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-15",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0066199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "T63857929",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srkelly@vcom.vt.edu",
            "affiliation": "N",
            "endpointDescription": "VCOM email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1411 S Potomac St Ste 300",
            "city": "Aurora",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800124539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.