NPIMap

Organization Active NPI

Elite Professional Providers, LLC

  • Family Medicine Physician
  • Springfield, MO
National Provider Identifier
1891488433
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ELITE PROFESSIONAL PROVIDERS, LLC
Practice address
3322 S Campbell Ave Ste T-1
Springfield, MO 65807-4980
Phone
(417) 220-4482
Fax
(417) 414-0017
NPI assigned
May 30, 2023
Last updated
Jul 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Authorized official

Name
Shawn Kelley
Title
Coo
Phone
(417) 220-4482

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Family Nurse Practitioner 363LF0000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU

Addresses

Primary practice location

3322 S Campbell Ave Ste T-1
Springfield, MO 65807-4980

Mailing address

2135 E Independence St # 1093
Springfield, MO 65804-3749
Phone (417) 220-4482

Other practice location 1

1655 S Enterprise Ave Ste A3
Springfield, MO 65804-1864
Phone (417) 220-4480

Other identifiers 1

IdentifierTypeStateIssuer
500128969MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230731003920 MO Part B Supplier - Clinic/Group Practice 1254792740 Receives reassigned benefits from 11 practitioners
Practice locations: Springfield, MO

National Provider Directory

National Provider Directory

Locations

3322 S Campbell Ave
Ste T1
Springfield, MO 65807
Phone (417) 220-4480

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1891488433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2135 E INDEPENDENCE ST # 1093",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658043749",
            "telephone_number": "417-220-4482",
            "fax_number": "417-414-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 S CAMPBELL AVE STE T-1",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074980",
            "telephone_number": "417-220-4482",
            "fax_number": "417-414-0017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1655 S Enterprise Ave Ste A3",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658041864",
            "country_code": "US",
            "telephone_number": "417-220-4480",
            "fax_number": "417-414-0017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELITE PROFESSIONAL PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-30",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "417-220-4482"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500128969",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.