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KELLY GIBBONS RDN
NPI 1053107938
Dietitian, Registered in Park City, UT

Active since April 16, 2025Accepts Medicare Assignment
900 ROUND VALLEY DR STE 110, PARK CITY, UT 84060(435) 633-3353 Get Directions Write a Review

NPPES record last updated: May 14, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kelly Gibbons Rdn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY GIBBONS RDN (NPI 1053107938) is an individual dietitian, registered in Park City, Utah, licensed in Utah (11092359-4901) and active in the NPI registry since April 2025. She is a graduate of Other (2022).

NPPES Registry Identity

NPI1053107938
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameKELLY GIBBONSCredential: RDN
Location Address900 ROUND VALLEY DR STE 110Park City, UT 84060-7552
Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128
Phone(435) 633-3353
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateApril 16, 2025
Last NPPES UpdateMay 14, 2025
NPPES CertifiedMay 14, 2025
✔ NPI 1053107938 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in UT · 11092359-4901
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
900 ROUND VALLEY DR STE 110, Park City, UT 84060
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, Select Health, University of Utah Health Plans.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 Gibbons Rdn 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.

PECOS PAC ID1052819612
PECOS Enrollment IDI20250812003774

Medicare Billing Reassignment

Medicare enrollment records show Kelly Gibbons reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ihc Health Services Inc
Same address
Maternal & Fetal Medicine
900 ROUND VALLEY DR
Park City, UT 84060
  • Reassigned Medicare billing, Utah enrollment
  • 3,691 clinicians in this Medicare group
NPI 1174396204 (435) 658-7400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.34 – $166.03
Typical copayment $0.00 (range $13.58 – $41.50)
Most-billed visit code NA
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARA SHIREY MS, RDN, CD
Dietitian, Registered
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 658-7894
MRS. COURTNEY N. WOOLSEY RD
Dietitian, Registered
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535
ZUI FANG L.AC
Acupuncturist
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535
DR. WYATT HARDING HORSLEY M.D.
Family Medicine
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535
HANNAH JANE LANGLEY RD
Dietitian, Registered
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535
KARY ELLEN WOODRUFF R.D., M.S., C.D.
Dietitian, Registered
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535
ANNA J HOLMAN MD
Family Medicine
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 658-6750
SONYA GREY
Massage Therapist
900 ROUND VALLEY DR STE 110
PARK CITY, UT 84060
Summit County (435) 333-3535

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 Gibbons's NPI number?

The NPI number for Kelly Gibbons is 1053107938. It was assigned to this individual provider in the NPPES registry on April 16, 2025.

Where is Kelly Gibbons located?

Kelly Gibbons practices at 900 Round Valley Dr Ste 110, Park City, UT 84060. The listed phone number is (435) 633-3353.

What is Kelly Gibbons's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Kelly Gibbons enrolled in Medicare?

Yes. Kelly Gibbons 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 Gibbons's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Gibbons reassigns Medicare benefits to Ihc Health Services Inc (Park City, UT). 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 Gibbons's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Gibbons accept?

Health plans from Molina Healthcare, Select Health and University of Utah Health Plans list Kelly Gibbons 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 Gibbons was last updated on May 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.