MRS. KELLY ANN GODBERSON NP
NPI 1053833962
Nurse Practitioner in Medford, NY

Q: What is Kelly Godberson's NPI number?

The NPI number for Kelly Godberson is 1053833962. It was assigned to this individual provider in the NPPES registry on July 12, 2017.

Q: What is Kelly Godberson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Godberson was last updated on July 12, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.

Active since July 12, 2017PECOS Enrolled

3115 HORSEBLOCK RD, MEDFORD, NY 11763(631) 730-3000 Get Directions Write a Review

NPPES record last updated: July 12, 2017. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Mrs. Kelly Ann Godberson Np NPPES

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

MRS. KELLY ANN GODBERSON NP (NPI 1053833962) is an individual nurse practitioner in Medford, New York, licensed in New York (308240) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1053833962

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameMRS. KELLY ANN GODBERSONCredential: NP

Location Address3115 HORSEBLOCK RDMedford, NY 11763-2526

Mailing Address32 Marlin RdCentereach, NY 11720-3012 · (631) 698-2823

Phone(631) 730-3000

Sole ProprietorYes

Medical School CMSOtherGraduated 2017

Enumeration DateJuly 12, 2017

✔ NPI 1053833962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in NY · 308240

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

3115 HORSEBLOCK RD, Medford, NY 11763

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Other Identifiers 1

Other308240NY · Nurse Practioner License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Kelly Ann Godberson Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1557635927

PECOS Enrollment IDI20170922003171

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Kelly Godberson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Kag Professional Nurse Practitioner In Adult Health PLLC

Same address

Adult Health

3115 HORSEBLOCK RD
Medford, NY 11763

Reassigned Medicare billing, New York enrollment

NPI 1295391985 (631) 872-2995

Nk Medical PC

6.2 mi

Nephrology

2 CORACI BLVD STE 11, WILLIAM FLOYD COMMONS
Shirley, NY 11967

Reassigned Medicare billing, New York enrollment
9 clinicians in this Medicare group

NPI 1467873018 (631) 281-4861

Suffolk Medical Specialist, PLLC

7.9 mi

Internal Medicine

1110 HALLOCK AVE
Port Jefferson Station, NY 11776

Reassigned Medicare billing, New York enrollment
2 clinicians in this Medicare group

NPI 1710950688 (631) 476-9100

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

Areas of Expertise CMS Part B claims 12

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

5,942 services1,014 patients

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305

An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.

997 services896 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308

A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.

707 services390 patients

Application of chemical to stop tissue regrowth in wound 17250

This procedure involves applying a special chemical to a wound to prevent unwanted tissue from growing back. It aids in proper healing by ensuring only healthy tissue regrows. It's a common, safe practice in wound care.

609 services40 patients

Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99304

An initial nursing facility visit is a daily check-up to monitor your health status. This service, lasting typically 25 minutes, involves a nurse assessing your overall wellbeing, discussing concerns, and updating your care plan as needed.

117 services113 patients

Removal of skin and tissue, 20.0 sq cm or less 11042

This procedure involves the surgical removal of skin and tissue, up to 20.0 square cm in size. It's often performed to treat conditions like skin cancer or to remove moles, warts, and other skin lesions. The area is numbed and the unwanted tissue is carefully cut out.

56 services31 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes 99307

A follow-up nursing facility visit per day typically lasts about 10 minutes. This service involves a healthcare professional checking on your health status, answering any questions you may have, and monitoring your progress. This routine check ensures your recovery is on track and any concerns are addressed promptly.

42 services30 patients

Replacement of stomach stoma tube 43762

A replacement of a stomach stoma tube is a procedure where your existing tube is removed and a new one is inserted. This helps ensure the tube functions properly, allowing nutrition directly into your stomach. It's a safe, routine process done by healthcare professionals.

27 services20 patients

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

22 services17 patients

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305

15 services15 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308

15 services12 patients

Simple change of bladder tube 51705

A simple change of bladder tube involves replacing your current urinary drainage tube with a new one. This is done to maintain hygiene and prevent infections. It's a straightforward process, usually causing minimal discomfort, and helps ensure your body can properly dispose of waste fluids.

13 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11763 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

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.

Referred Medical Equipment & Supplies CMS DME claims 18

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Urinary catheter anchoring device, adhesive skin attachment, each A4333

DME-Orthotic Devices · category DF000N

1 supplier13 claims156 services$1.98 avg. paid by Medicare

Urinary catheter anchoring device, leg strap, each A4334

DME-Orthotic Devices · category DF000N

1 supplier13 claims13 services$4.40 avg. paid by Medicare

Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each A4358

DME-Orthotic Devices · category DF000N

1 supplier13 claims26 services$5.24 avg. paid by Medicare

Tape, non-waterproof, per 18 square inches A4450

DME-Medical/Surgical Supplies · category DA000N

2 suppliers25 claims2,720 services$0.10 avg. paid by Medicare

Tape, waterproof, per 18 square inches A4452

DME-Medical/Surgical Supplies · category DA000N

2 suppliers23 claims2,668 services$0.37 avg. paid by Medicare

Appliance cleaner, incontinence and ostomy appliances, per 16 oz. A5131

DME-Orthotic Devices · category DF000N

1 supplier13 claims13 services$14.15 avg. paid by Medicare

Collagen based wound filler, dry form, sterile, per gram of collagen A6010