KELLY ANN PETTIT PSYD
NPI 1194999409
Psychologist - Clinical in Mchenry, IL
About Kelly Ann Pettit Psyd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY ANN PETTIT PSYD (NPI 1194999409) is an individual clinical provider in Mchenry, Illinois, licensed in Iowa (117693) and active in the NPI registry since April 2008. She is enrolled in Medicare PECOS, maintains 4 additional practice locations, and is a graduate of Other (2008).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 4
Other Identifiers 1
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 Ann Pettit Psyd 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.
Medicare Billing Reassignments
3Medicare enrollment records show Kelly Pettit reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Mchenry, IL 60050
- Reassigned Medicare billing, Illinois enrollment
- 6 clinicians in this Medicare group
San Antonio, TX 78240
- Reassigned Medicare billing, Illinois enrollment
- 29 clinicians in this Medicare group
Las Cruces, NM 88011
- Reassigned Medicare billing, Iowa enrollment
- 21 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.
Areas of Expertise CMS Part B claims 5
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 60050 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 3
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 Kelly Pettit's NPI number?
The NPI number for Kelly Pettit is 1194999409. It was assigned to this individual provider in the NPPES registry on April 17, 2008.
Where is Kelly Pettit located?
Kelly Pettit practices at 659 Ridgeview Dr, Mchenry, IL 60050. The listed phone number is (815) 344-1999.
What is Kelly Pettit's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Kelly Pettit enrolled in Medicare?
Yes. Kelly Pettit 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 organizations bill Medicare for Kelly Pettit's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Pettit reassigns Medicare benefits to 3 organizations: Neuroclinic And Assessments, LLC (Mchenry, IL), Deer Oaks Mid-West LLC (San Antonio, TX) and Deer Oaks Mental Health Associates PC (Las Cruces, NM). Each 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 Pettit'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 Pettit was last updated on May 29, 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 Ann Pettit, PSYD · NPI 1194999409
Clinical provider in Mchenry, Illinois. Individual provider, active in the CMS NPPES registry since April 17, 2008.
## Identity
- **NPI:** 1194999409 (Entity type: Individual)
- **Enumerated:** April 17, 2008
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 117693 (Iowa)
- **Sole proprietor:** No
## Practice location
- **Address:** 659 RIDGEVIEW DR, Mchenry, IL 60050-7012
- **Phone:** (815) 344-1999
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Neuroclinic And Assessments, LLC (NPI 1053673988, Mchenry, IL); Deer Oaks Mid-West LLC (NPI 1154978476, San Antonio, TX); Deer Oaks Mental Health Associates PC (NPI 1134175763, Las Cruces, NM) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2008
## Record status
- **NPPES last updated:** May 29, 2023
- **Other identifiers:** Other 071007917 (IL)
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Source: [NPI Profile](https://npiprofile.com/npi/1194999409) · Data from the CMS NPPES public registry.