Carrie L Kelly, LPC, SACIT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4558-125 Issued in WI

Practice address

W4051 County Road NN
Elkhorn, WI 53121-4338

Phone

(262) 741-3200

Fax

(262) 741-3217

NPI assigned

Apr 23, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment Care Compare group NPD
• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Pewaukee, WI
  • NPI 1396887709
  NPD

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1821263724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1005",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531211005",
            "telephone_number": "262-741-3200",
            "fax_number": "262-741-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4051 COUNTY ROAD NN",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214338",
            "telephone_number": "262-741-3200",
            "fax_number": "262-741-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CARRIE",
        "middle_name": "L",
        "credential": "LPC, SACIT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4558-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821263724",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30604011",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ewelina I Jurczyk, M.D.
• Ashley Justen, RN
• Bridget A Kampman, M.D
• Karlik Chiropractic Center, S.C.
• Donn Frederick Karlik, D.C.
• Jacqueline C Kerkman, DPT, MS, LAT
• Kettle Moraine Health & Wellness LLC (United Chiropractic Sports & Reha)
• Muzaffar Khan, MD
• E Christine Kienbaum
• Aric Kinney, PT

• Professional Counselor in Elkhorn, WI
• Providers in Elkhorn, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.