Individual provider Active NPI

Kelsi Marie Rau, RN, NP

  • Nurse Practitioner
  • Simi Valley, CA
National Provider Identifier
1972173359
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95028896 Issued in CA
Practice address
1424 Madera Rd
Simi Valley, CA 93065-3053
Phone
(805) 522-5722
NPI assigned
Jun 29, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2346727 MA
Nurse Practitioner 363L00000X 95028896 CA Primary
Nurse Practitioner 363L00000X 2346727 MA

Addresses

Primary practice location

1424 Madera Rd
Simi Valley, CA 93065-3053

Mailing address

137 Peterborough St Apt 14
Boston, MA 02215-4212
Phone (904) 238-5215

Other practice location 1

137 Peterborough St Apt 14
Boston, MA 02215-4212
Phone (904) 238-5215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220128001560 MA Practitioner - Nurse Practitioner 0244622033 Reassigns benefits to 1 organization
I20240412003730 CA Practitioner - Nurse Practitioner 0244622033 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2346727MAMDRegistered Nurse
95028896CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lynn Community Health, Inc. CurrentSince Feb 14, 2022 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Apr 1, 2024 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Apr 1, 2024 Accepting new patients
Clinicas del Camino Real Inc Current Accepting new patients

Locations

730 Paseo Camarillo
Camarillo, CA 93010
Phone (805) 920-7021

500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895

1424 Madera Rd
Simi Valley, CA 93065
Phone (805) 522-5722

269 Union St
Lynn, MA 01901
Phone (781) 581-9832

280 Union St
Ste 202
Lynn, MA 01901
Phone (781) 780-4555

Interoperability endpoints

  • Direct secure messaging: krau320149@direct.ochin.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1972173359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 PETERBOROUGH ST APT 14",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154212",
            "telephone_number": "904-238-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 MADERA RD",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653053",
            "telephone_number": "805-522-5722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "137 Peterborough St Apt 14",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022154212",
            "country_code": "US",
            "telephone_number": "904-238-5215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAU",
        "first_name": "KELSI",
        "middle_name": "MARIE",
        "credential": "RN, NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-29",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "2346727",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95028896",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "2346727",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.