KELLY LEE ROSE LMFT
NPI 1003170143
Counselor - Mental Health in Wayzata, MN
About Kelly Lee Rose Lmft NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY LEE ROSE LMFT (NPI 1003170143) is an individual mental health provider in Wayzata, Minnesota and active in the NPI registry since July 2012. She is enrolled in Medicare PECOS and is a graduate of Other (2011).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelly Lee Rose Lmft is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Kelly Rose reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Wayzata, MN 55391
- Reassigned Medicare billing, Minnesota enrollment
- 5 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WAYZATA, MN 55391
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Rose's NPI number?
The NPI number for Kelly Rose is 1003170143. It was assigned to this individual provider in the NPPES registry on July 3, 2012.
Where is Kelly Rose located?
Kelly Rose practices at 3701 Shoreline Dr Ste 102A 102A, Wayzata, MN 55391. The listed phone number is (651) 231-7471.
What is Kelly Rose's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Kelly Rose enrolled in Medicare?
Yes. Kelly Rose is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Kelly Rose's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Rose reassigns Medicare benefits to Lakeshore Family Therapy LLC (Wayzata, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Rose's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Rose accept?
Health plans from HealthPartners list Kelly Rose as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kelly Rose was last updated on May 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Lee Rose, LMFT · NPI 1003170143
Mental Health provider in Wayzata, Minnesota. Individual provider, active in the CMS NPPES registry since July 3, 2012.
## Identity
- **NPI:** 1003170143 (Entity type: Individual)
- **Enumerated:** July 3, 2012
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3701 SHORELINE DR STE 102A, 102A, Wayzata, MN 55391-4000
- **Phone:** (651) 231-7471
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Lakeshore Family Therapy LLC (NPI 1699179994, Wayzata, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2011
## Record status
- **NPPES last updated:** May 30, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1003170143) · Data from the CMS NPPES public registry.