GEORGIA KELLY-WILLIAMS
NPI 1104545037
Nurse Practitioner - Psychiatric/Mental Health in Deer Park, NY

Active since August 24, 2022PECOS EnrolledAccepts Medicare Assignment
52 TIBER AVE, DEER PARK, NY 11729(631) 404-8843 Get Directions Write a Review

NPPES record last updated: August 24, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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

NPI1104545037
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameGEORGIA KELLY-WILLIAMS
Location Address52 TIBER AVEDeer Park, NY 11729-7012
Mailing Address52 Tiber AveDeer Park, NY 11729-7012 · (631) 404-8843
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateAugust 24, 2022
NPPES CertifiedAugust 24, 2022
NPI 1104545037 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License Licensed in NY · 404380
52 TIBER AVE, Deer Park, NY 11729

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID8224400262
PECOS Enrollment IDI20230221000678
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.

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.

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.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104545037, enumerated as an "individual" on August 24, 2022.

The provider is located at 52 TIBER AVE DEER PARK, NY 11729 and the phone number is (631) 404-8843.

Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.