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KELLY L KELLERMAN LCSW
NPI 1073534384
Social Worker - Clinical in Charlotte, NC

Active since July 21, 2006PECOS EnrolledAccepts Medicare Assignment
5700 EXECUTIVE CENTER DR, SUITE 110, CHARLOTTE, NC 28212(704) 525-3255(704) 525-0949 Get Directions Write a Review

NPPES record last updated: March 13, 2017. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kelly L Kellerman Lcsw NPPES

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

KELLY L KELLERMAN LCSW (NPI 1073534384) is an individual clinical provider in Charlotte, North Carolina, licensed in North Carolina (C002690) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1993).

NPPES Registry Identity

NPI1073534384
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLY L KELLERMANCredential: LCSW
Location Address5700 EXECUTIVE CENTER DR, SUITE 110Charlotte, NC 28212-8858
Mailing Address350 Pee Dee Ave, Suite 101Albemarle, NC 28001-4932 · (704) 986-1500 · Fax (704) 982-5279
Phone(704) 525-3255
Fax(704) 525-0949
Sole ProprietorNo
Medical School CMSOtherGraduated 1993
Enumeration DateJuly 21, 2006
Last NPPES UpdateMarch 13, 2017
✔ NPI 1073534384 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NC · C002690
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
5700 EXECUTIVE CENTER DR, Charlotte, NC 28212
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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 L Kellerman Lcsw 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 ID3375855307
PECOS Enrollment IDI20181024001629
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 Reassignment

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

Thrive Counseling LLC
177 mi
Mental Health
1000 JEFFERSON ST STE 2C
Lynchburg, VA 24504
  • Reassigned Medicare billing, Michigan enrollment
  • 123 clinicians in this Medicare group
NPI 1215181300 (855) 284-7483

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 28212 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 $54.12 – $165.09
Typical copayment $0.00 (range $13.53 – $41.27)
Most-billed visit code NA
Established Patient
$67.72 typical visit price
range $17.21 – $134.61
Typical copayment $16.93 (range $4.30 – $33.65)
Most-billed visit code 99213
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 20

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

EASTERSEALS UCP
Case Management
5700 EXECUTIVE CENTER DR, SUITE 110
CHARLOTTE, NC 28212
Mecklenburg County (704) 566-6040
LATARSHA ANN STEELE LCSWA
Social Worker (Clinical)
5700 EXECUTIVE CENTER DR, STE 200
CHARLOTTE, NC 28212
Mecklenburg County (704) 330-4338
LEEANNE THOMPSON-FORTE LCSW-A
Social Worker (Clinical)
5700 EXECUTIVE CENTER DR
CHARLOTTE, NC 28212
Mecklenburg County (803) 431-1132
MRS. ERIN L CAMPBELL OTRL
Occupational Therapist
5700 EXECUTIVE CENTER DR, SUITE 115
CHARLOTTE, NC 28212
Mecklenburg County (704) 566-6040
CORNERSTONE COMMUNITY OUTREACH
Community/Behavioral Health
5700 EXECUTIVE CENTER DR, SUITE 214
CHARLOTTE, NC 28212
Mecklenburg County (704) 817-7786
TRUE BEHAVIORAL HEALTHCARE, INC.
Community/Behavioral Health
5700 EXECUTIVE CENTER DR, SUITE 216
CHARLOTTE, NC 28212
Mecklenburg County (704) 566-3460
MISS TINA RENEE GREEN LCSW-A
Social Worker (Clinical)
5700 EXECUTIVE CENTER DR
CHARLOTTE, NC 28212
Mecklenburg County (803) 614-4503
EASTERSEALS UCP NORTH CAROLINA
Community/Behavioral Health
5700 EXECUTIVE CENTER DR, SUITE 110
CHARLOTTE, NC 28212
Mecklenburg County (704) 566-6040

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 Kellerman's NPI number?

The NPI number for Kelly Kellerman is 1073534384. It was assigned to this individual provider in the NPPES registry on July 21, 2006.

Where is Kelly Kellerman located?

Kelly Kellerman practices at 5700 Executive Center Dr Suite 110, Charlotte, NC 28212. The listed phone number is (704) 525-3255.

What is Kelly Kellerman's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kelly Kellerman enrolled in Medicare?

Yes. Kelly Kellerman 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 Kellerman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Kellerman reassigns Medicare benefits to Thrive Counseling LLC (Lynchburg, VA). 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 Kellerman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Kellerman accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 3 other insurers list Kelly Kellerman 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 Kellerman was last updated on March 13, 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.