Individual provider Active NPI

David N Kelbaugh Jr., PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Des Moines, IA
National Provider Identifier
1922731470
Registry record updated Nov 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
G170194 Issued in IA
Practice address
699 Walnut St Ste 400
Des Moines, IA 50309-3962
Phone
(515) 416-8830
Fax
(262) 260-9109
NPI assigned
Jul 1, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2023

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X TEMP276517 AZ
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G170194 IA Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61337914 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 847938 NV
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 276517 AZ
Registered Nurse 163W00000X 169476 IA
Registered Nurse 163W00000X 847938 NV
Registered Nurse 163W00000X 276517 AZ

Addresses

Primary practice location

699 Walnut St Ste 400
Des Moines, IA 50309-3962

Mailing address

7426 N la Cholla Blvd
Tucson, AZ 85741-2306
Phone (520) 771-0555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20221202001723 WA Practitioner - Nurse Practitioner 5193194793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

6505 216TH St SW
Suite 100
Mountlake Terrace, WA 98043-2089
Phone (425) 640-7009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TEMP276517AZMDRegistered Nurse
169476IAMDRegistered Nurse
276517AZMDPsychiatric/Mental Health Nurse Practitioner
847938NVMDPsychiatric/Mental Health Nurse Practitioner
AP61337914WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC Psychiatric/Mental Health CurrentSince Nov 22, 2022 Accepting new patients
Forefront-Rosenzweig Medical Services Professional Corporation CurrentSince Mar 17, 2023 Accepting new patients

Locations

1633 N Mountain Ave
Upland, CA 91784

200 American Metro Blvd
Ste 112
Trenton, NJ 08619

1305 Alexander St
Centralia, WA 98531
Phone (360) 736-2823

1919 112th St SW
Everett, WA 98204
Phone (425) 249-0024

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

529 Jasmine St
Omak, WA 98841
Phone (509) 826-1600

101 Elliott Ave W
Ste 500
Seattle, WA 98119
Phone (206) 708-6432

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

820 NW 95th St
Seattle, WA 98117
Phone (206) 781-6800

1780 Barnes Blvd SW
Tumwater, WA 98512
Phone (212) 993-7809

Interoperability endpoints

  • Direct secure messaging: david.kelbaugh.1@24287.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699660800000",
    "number": "1922731470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7426 N LA CHOLLA BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857412306",
            "telephone_number": "520-771-0555",
            "fax_number": "262-260-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 WALNUT ST STE 400",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503093962",
            "telephone_number": "515-416-8830",
            "fax_number": "262-260-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELBAUGH",
        "first_name": "DAVID",
        "middle_name": "N",
        "name_suffix": "Jr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-01",
        "last_updated": "2023-11-11",
        "certification_date": "2023-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "TEMP276517",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G170194",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61337914",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "847938",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "276517",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IA",
            "license": "169476",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "847938",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "276517",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.