GEORGIA KELLY-WILLIAMS
NPI 1104545037
Nurse Practitioner - Psychiatric/Mental Health in Deer Park, NY
About Georgia Kelly-williams NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GEORGIA KELLY-WILLIAMS (NPI 1104545037) is an individual psychiatric/mental health provider in Deer Park, New York, licensed in New York (404380) and active in the NPI registry since August 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).
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
Georgia Kelly-williams 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
2Medicare enrollment records show Georgia Kelly-williams reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Amityville, NY 11701
- Reassigned Medicare billing, New York enrollment
- Medicare enrollment name: Cs Medical Associates, PC
- 81 clinicians in this Medicare group
Howell, NJ 07731
- Reassigned Medicare billing, New York enrollment
- 156 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 11729 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 Georgia Kelly-williams's NPI number?
The NPI number for Georgia Kelly-williams is 1104545037. It was assigned to this individual provider in the NPPES registry on August 24, 2022.
Where is Georgia Kelly-williams located?
Georgia Kelly-williams practices at 52 Tiber Ave, Deer Park, NY 11729. The listed phone number is (631) 404-8843.
What is Georgia Kelly-williams's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Georgia Kelly-williams enrolled in Medicare?
Yes. Georgia Kelly-williams 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 Georgia Kelly-williams's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Georgia Kelly-williams reassigns Medicare benefits to 2 organizations: Cs Medical Associates, P.C. (Amityville, NY) and Supportive Care Psychology Of Ny PC (Howell, NJ). 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 Georgia Kelly-williams'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 Georgia Kelly-williams was last updated on August 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Georgia Kelly-Williams · NPI 1104545037
Psychiatric/Mental Health physician in Deer Park, New York. Individual provider, active in the CMS NPPES registry since August 24, 2022.
## Identity
- **NPI:** 1104545037 (Entity type: Individual)
- **Enumerated:** August 24, 2022
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 404380 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 52 TIBER AVE, Deer Park, NY 11729-7012
- **Phone:** (631) 404-8843
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** August 24, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1104545037) · Data from the CMS NPPES public registry.