KELLY T PHAM
NPI 1114231669
Psychologist - Clinical in Modesto, CA
About Kelly T Pham NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY T PHAM (NPI 1114231669) is an individual clinical provider in Modesto, California, licensed in California (PSY29070) and active in the NPI registry since July 2010. She is enrolled in Medicare PECOS.
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)
Kelly T Pham is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Pham reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Napa, CA 94558
- Reassigned Medicare billing, California enrollment
- 755 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 95354 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 Kelly Pham's NPI number?
The NPI number for Kelly Pham is 1114231669. It was assigned to this individual provider in the NPPES registry on July 27, 2010.
Where is Kelly Pham located?
Kelly Pham practices at 1015 12th St Ste 2, Modesto, CA 95354. The listed phone number is (209) 496-2327.
What is Kelly Pham's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Kelly Pham enrolled in Medicare?
Yes. Kelly Pham is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Pham's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Pham reassigns Medicare benefits to Department Of State Hospitals (Napa, CA). 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 Kelly Pham'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 Kelly Pham was last updated on January 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Kelly T Pham · NPI 1114231669
Clinical provider in Modesto, California. Individual provider, active in the CMS NPPES registry since July 27, 2010.
## Identity
- **NPI:** 1114231669 (Entity type: Individual)
- **Enumerated:** July 27, 2010
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** PSY29070 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1015 12TH ST STE 2, Modesto, CA 95354-0838
- **Phone:** (209) 496-2327
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Department Of State Hospitals (NPI 1326098161, Napa, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 22, 2023
---
Source: [NPI Profile](https://npiprofile.com/npi/1114231669) · Data from the CMS NPPES public registry.