KELLY SUSAN DAVIS
NPI 1093143554
Counselor - Mental Health in San Rafael, CA
About Kelly Susan Davis NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY SUSAN DAVIS (NPI 1093143554) is an individual mental health provider in San Rafael, California and active in the NPI registry since October 2013. She is enrolled in Medicare PECOS and is a graduate of Other (2013).
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 Susan Davis 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 Reassignments
3Medicare enrollment records show Kelly Davis reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Tampa, FL 33602
- Reassigned Medicare billing, Florida enrollment
- 75 clinicians in this Medicare group
Maitland, FL 32751
- Reassigned Medicare billing, Florida enrollment
- 47 clinicians in this Medicare group
Shelton, CT 06484
- Reassigned Medicare billing, Florida enrollment
- 23 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 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Davis's NPI number?
The NPI number for Kelly Davis is 1093143554. It was assigned to this individual provider in the NPPES registry on October 21, 2013.
Where is Kelly Davis located?
Kelly Davis practices at 900 5th Ave Suite 150, San Rafael, CA 94901. The listed phone number is (415) 457-6964.
What is Kelly Davis's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Kelly Davis enrolled in Medicare?
Yes. Kelly Davis 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 organizations bill Medicare for Kelly Davis's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Davis reassigns Medicare benefits to 3 organizations: Quality Bhs Florida, LLC (Tampa, FL), Telos Health Systems Fl LLC (Maitland, FL) and Chestnut Knoll Physicians Group PC (Shelton, CT). Each 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 Davis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Davis accept?
Health plans from Cigna HealthCare of Florida, Inc., Cigna Healthcare, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company) and Oscar Health Maintenance Organization of Florida and 2 other insurers list Kelly Davis 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 Davis was last updated on March 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.
# Kelly Susan Davis · NPI 1093143554
Mental Health provider in San Rafael, California. Individual provider, active in the CMS NPPES registry since October 21, 2013.
## Identity
- **NPI:** 1093143554 (Entity type: Individual)
- **Enumerated:** October 21, 2013
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Sole proprietor:** No
## Practice location
- **Address:** 900 5TH AVE, SUITE 150, San Rafael, CA 94901-2959
- **Phone:** (415) 457-6964
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Quality Bhs Florida, LLC (NPI 1689297541, Tampa, FL); Telos Health Systems Fl LLC (NPI 1801624242, Maitland, FL); Chestnut Knoll Physicians Group PC (NPI 1780477729, Shelton, CT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2013
## Record status
- **NPPES last updated:** March 10, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1093143554) · Data from the CMS NPPES public registry.