KELSOM CLINIC PA
NPI 1104840594
Family Medicine in Irving, TX
About Kelsom Clinic Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELSOM CLINIC PA (NPI 1104840594) is a healthcare organization registered as a family medicine in Irving, Texas and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through January 13, 2028, maintains a secondary practice location in Mesquite, and lists Catherine Okoronkwo, Md, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelsom Clinic Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
9Medicare enrollment records show 9 clinicians reassign Medicare billing to Kelsom Clinic PA, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.
Clinicians, nearest first (9)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D0995230
Kelsom Clinic Inc · Irving, TXFrequently 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 Kelsom Clinic PA's NPI number?
The NPI number for Kelsom Clinic PA is 1104840594. It was assigned to this organization in the NPPES registry on July 27, 2006.
Where is Kelsom Clinic PA located?
Kelsom Clinic PA is located at 1202 W Pioneer Dr Ste 100, Irving, TX 75061. The listed phone number is (972) 254-7272.
What is Kelsom Clinic PA's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Kelsom Clinic PA enrolled in Medicare?
Yes. Kelsom Clinic PA is registered in the Medicare PECOS enrollment system.
When is Kelsom Clinic PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Kelsom Clinic PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 2 Medicare specialties reassign their Medicare billing to Kelsom Clinic PA. A 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 the clinician's services. The largest specialties are Nurse Practitioner (8) and Internal Medicine (1). Of these, 1 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Kelsom Clinic PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D0995230) is associated with this NPI, valid through January 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Kelsom Clinic PA accept?
Health plans from Molina Healthcare list Kelsom Clinic PA 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 Kelsom Clinic PA was last updated on January 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Kelsom Clinic Pa · NPI 1104840594
Family Medicine organization in Irving, Texas. Organization record, active in the CMS NPPES registry since July 27, 2006.
## Identity
- **NPI:** 1104840594 (Entity type: Organization)
- **Enumerated:** July 27, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** Yes (part of Kelsom Clinic Pa)
- **Authorized official:** Catherine Okoronkwo, MD
## Practice location
- **Address:** 1202 W PIONEER DR STE 100, Irving, TX 75061-7309
- **Phone:** (972) 254-7272 · **Fax:** (972) 254-7575
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 9 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (8), Internal Medicine (1); 1 practice at this address and 4 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 20, 2026
- **Other identifiers:** Medicaid 160977801 (TX)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104840594) · Data from the CMS NPPES public registry.