SHELLEY BETH KINGSBURY LCSW
NPI 1104462654
Social Worker - Clinical in Mystic, CT
About Shelley Beth Kingsbury Lcsw NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHELLEY BETH KINGSBURY LCSW (NPI 1104462654) is an individual clinical provider in Mystic, Connecticut, licensed in Connecticut (010666) and active in the NPI registry since November 2019. She is enrolled in Medicare PECOS and is a graduate of Fordham University School Of Medicine (2016).
NPPES Registry Identity
Specialties & Licenses
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
Shelley Beth Kingsbury 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.
Medicare Billing Reassignments
3Medicare enrollment records show Shelley Kingsbury reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Norwich, CT 06360
- Reassigned Medicare billing, Connecticut enrollment
- Also billed through NPI 1427074426 (Connecticut)
- 57 clinicians in this Medicare group
Norwich, CT 06360
- Reassigned Medicare billing, Connecticut enrollment
- 430 clinicians in this Medicare group
Willimantic, CT 06226
- Reassigned Medicare billing, Connecticut enrollment
- 302 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 06355 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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 Shelley Kingsbury's NPI number?
The NPI number for Shelley Kingsbury is 1104462654. It was assigned to this individual provider in the NPPES registry on November 20, 2019.
Where is Shelley Kingsbury located?
Shelley Kingsbury practices at 1101 Noank Ledyard Rd # 12, Mystic, CT 06355. The listed phone number is (860) 861-8393.
What is Shelley Kingsbury's specialty?
The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.
Is Shelley Kingsbury enrolled in Medicare?
Yes. Shelley Kingsbury 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 Shelley Kingsbury's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shelley Kingsbury reassigns Medicare benefits to 3 organizations: State Of Connecticut (Norwich, CT), The William W Backus Hospital (Norwich, CT) and Windham Community Memorial Hospital, Inc. (Willimantic, 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 Shelley Kingsbury's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Shelley Kingsbury was last updated on August 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Shelley Beth Kingsbury, LCSW · NPI 1104462654
Clinical provider in Mystic, Connecticut. Individual provider, active in the CMS NPPES registry since November 20, 2019.
## Identity
- **NPI:** 1104462654 (Entity type: Individual)
- **Enumerated:** November 20, 2019
- **Primary specialty:** Social Worker - Clinical · taxonomy 1041C0700X
- **State license:** 010666 (Connecticut)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1101 NOANK LEDYARD RD # 12, Mystic, CT 06355-1361
- **Phone:** (860) 861-8393
## 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): State Of Connecticut (NPI 1902831548, Norwich, CT); The William W Backus Hospital (NPI 1467517235, Norwich, CT); Windham Community Memorial Hospital, Inc. (NPI 1023191467, Willimantic, CT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Fordham University School Of Medicine, class of 2016
## Record status
- **NPPES last updated:** August 26, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1104462654) · Data from the CMS NPPES public registry.