NPIMap

Individual provider Active NPI

Jennifer Kelly

  • Adult Health Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1962804880
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
3008785 Issued in KY
Practice address
3841 Ruckriegel Pkwy
Louisville, KY 40299-3986
Phone
(502) 791-8700
Fax
(502) 742-8523
NPI assigned
Sep 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 3008785 KY
Adult Health Nurse Practitioner 363LA2200X 3008785 KY Primary

Addresses

Primary practice location

3841 Ruckriegel Pkwy
Louisville, KY 40299-3986

Mailing address

600 Cross Pointe Rd
Suite a
Gahanna, OH 43230-6696
Phone (513) 725-2186

Other identifiers 1

IdentifierTypeStateIssuer
7100365330MedicaidKY

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jkelly143782@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20150910002877 KY Practitioner - Nurse Practitioner 5395052112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New Horizons Physical Therapy Limited PartnershipGroup PAC ID 4183641608, 77 clinicians
Norton Hospitals, IncGroup PAC ID 9830001528, 137 clinicians
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

2125 State St
Suite 2
New Albany, IN 47150-4972

2355 Poplar Level Rd
Suite 304
Louisville, KY 40217-1388
Phone (502) 629-5455

315 E Broadway
Suite 185 C
Louisville, KY 40202-3702
Phone (502) 629-5455

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3008785KYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Jun 1, 2018 Accepting new patients
Community Medical Associates, Inc. Adult Health Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Jun 1, 2018 Accepting new patients

Locations

315 E Broadway
Ste 185C
Louisville, KY 40202
Phone (502) 629-5455

210 E Gray St
Ste 803
Louisville, KY 40202
Phone (502) 582-6900

4915 Norton Healthcare Blvd
Ste 404
Louisville, KY 40241
Phone (502) 629-5455

2355 Poplar Level Rd
Ste 304
Louisville, KY 40217
Phone (502) 629-5455

315 E Broadway
Ste 185
Louisville, KY 40202
Phone (502) 629-4150

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

Interoperability endpoints

  • Direct secure messaging: jkelly143782@direct.nortonhealthcare.org

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 and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1962804880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CROSS POINTE RD",
            "address_2": "SUITE A",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432306696",
            "telephone_number": "513-725-2186",
            "fax_number": "614-577-1427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 RUCKRIEGEL PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402993986",
            "telephone_number": "502-791-8700",
            "fax_number": "502-742-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KY",
            "license": "3008785",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "3008785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100365330",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkelly143782@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "315 E Broadway Ste 185-C",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402023700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "315 E Broadway Ste 185-C",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402023700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.