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KELLY SIMON
NPI 1164916151
Counselor - Mental Health in Maple Grove, MN

Active since June 21, 2018PECOS EnrolledAccepts Medicare Assignment
12918 63RD AVE N, MAPLE GROVE, MN 55369(612) 554-3737 Get Directions Write a Review

NPPES record last updated: January 8, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 8, 2026, Jun 21, 2018 (2 updates tracked since 2018).

About Kelly Simon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY SIMON (NPI 1164916151) is an individual mental health provider in Maple Grove, Minnesota and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1164916151
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLY SIMON
Location Address12918 63RD AVE NMaple Grove, MN 55369-6001
Mailing Address4624 Deerwood DrMinnetonka, MN 55343-8679
Phone(612) 554-3737
Sole ProprietorYes
Medical School CMSOtherGraduated 2014
Enumeration DateJune 21, 2018
Last NPPES UpdateJanuary 8, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2026
✔ NPI 1164916151 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
12918 63RD AVE N, Maple Grove, MN 55369
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

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

Kelly Simon 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 ID6204272016
PECOS Enrollment IDI20260311001696
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.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Simon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kelly Simon Counseling And Wellness LLC
10 mi
Adult Mental Health
32 10TH AVE S STE 212
Hopkins, MN 55343
  • Reassigned Medicare billing, Minnesota enrollment
NPI 1972359818 (612) 314-5652

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 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALYSHA KVAM
Counselor (Mental Health)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
MATTHEW THIEDE
Counselor (Mental Health)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
BETHANY R DILLON MA, LPCC, CCTP
Counselor (Mental Health)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (651) 238-1855
ECHO ANNE ALTHOFF
Marriage & Family Therapist
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
COLLABORATIVE COUNSELING LLC
Counselor (Mental Health)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
MISS NAOMI NICOLE DORIOTT LARSON M.A., LPC
Counselor (Professional)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
CHRISTINA BUSCKO LPCC
Counselor (Mental Health)
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966
MELISSA PAVLIK LMFT
Marriage & Family Therapist
12918 63RD AVE N
MAPLE GROVE, MN 55369
Hennepin County (763) 210-9966

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 Simon's NPI number?

The NPI number for Kelly Simon is 1164916151. It was assigned to this individual provider in the NPPES registry on June 21, 2018.

Where is Kelly Simon located?

Kelly Simon practices at 12918 63rd Ave N, Maple Grove, MN 55369. The listed phone number is (612) 554-3737.

What is Kelly Simon's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kelly Simon enrolled in Medicare?

Yes. Kelly Simon 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 organization bills Medicare for Kelly Simon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Simon reassigns Medicare benefits to Kelly Simon Counseling And Wellness LLC (Hopkins, MN). 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 Simon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Simon accept?

Health plans from HealthPartners list Kelly Simon 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 Kelly Simon was last updated on January 8, 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.