DR. CAMERON RYAN KELLY DC
NPI 1104605666
Student in an Organized Health Care Education/Training Program in Mount Dora, FL
About Dr. Cameron Ryan Kelly Dc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. CAMERON RYAN KELLY DC (NPI 1104605666) is an individual student in an organized health care education/training program in Mount Dora, Florida and active in the NPI registry since September 2023. He is a graduate of Palmer College Chiropractic - Davenport (2023).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Cameron Ryan Kelly Dc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Cameron Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Eustis, FL 32726
- Reassigned Medicare billing, Florida enrollment
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
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 Cameron Kelly's NPI number?
The NPI number for Cameron Kelly is 1104605666. It was assigned to this individual provider in the NPPES registry on September 25, 2023.
Where is Cameron Kelly located?
Cameron Kelly practices at 343 Stanley Bell Dr, Mount Dora, FL 32757. The listed phone number is (407) 937-9674.
What is Cameron Kelly's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Cameron Kelly enrolled in Medicare?
Yes. Cameron Kelly is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Cameron Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Cameron Kelly reassigns Medicare benefits to Revamp Chiropractic (Eustis, FL). 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 Cameron Kelly'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 Cameron Kelly was last updated on November 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Dr. Cameron Ryan Kelly, DC · NPI 1104605666
Student in an Organized Health Care Education/Training Program provider in Mount Dora, Florida. Individual provider, active in the CMS NPPES registry since September 25, 2023.
## Identity
- **NPI:** 1104605666 (Entity type: Individual)
- **Enumerated:** September 25, 2023
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 343 STANLEY BELL DR, Mount Dora, FL 32757-5919
- **Phone:** (407) 937-9674
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Revamp Chiropractic (NPI 1710879002, Eustis, FL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Palmer College Chiropractic - Davenport, class of 2023
## Record status
- **NPPES last updated:** November 5, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1104605666) · Data from the CMS NPPES public registry.