MS. KIM ELLEN M.A., L.P.C.
NPI 1205025079
Counselor in Wilmington, NC
About Ms. Kim Ellen M.a., L.p.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. KIM ELLEN M.A., L.P.C. (NPI 1205025079) is an individual counselor in Wilmington, North Carolina, licensed in Michigan (6401009255) and active in the NPI registry since October 2007. She is enrolled in Medicare PECOS and is a graduate of Other (2004).
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 and accepts Medicare assignment
Ms. Kim Ellen M.a., L.p.c. 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 Reassignment
Medicare enrollment records show Kim Ellen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Wilmington, NC 28403
- Reassigned Medicare billing, North Carolina enrollment
- 7 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.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WILMINGTON, NC 28412
WILMINGTON, NC 28412
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 Kim Ellen's NPI number?
The NPI number for Kim Ellen is 1205025079. It was assigned to this individual provider in the NPPES registry on October 17, 2007.
Where is Kim Ellen located?
Kim Ellen practices at 615 Shipyard Blvd, Wilmington, NC 28412. The listed phone number is (910) 343-0145.
What is Kim Ellen's specialty?
The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.
Is Kim Ellen enrolled in Medicare?
Yes. Kim Ellen 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 Kim Ellen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kim Ellen reassigns Medicare benefits to Chrysalis Center For Counseling And Eating Disorder Treatment PLLC (Wilmington, NC). 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 Kim Ellen'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 Kim Ellen was last updated on December 16, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Ms. Kim Ellen, M.A., L.P.C. · NPI 1205025079
Counselor provider in Wilmington, North Carolina. Individual provider, active in the CMS NPPES registry since October 17, 2007.
## Identity
- **NPI:** 1205025079 (Entity type: Individual)
- **Enumerated:** October 17, 2007
- **Primary specialty:** Counselor · taxonomy 101Y00000X
- **State license:** 6401009255 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 615 SHIPYARD BLVD, Wilmington, NC 28412-6431
- **Phone:** (910) 343-0145
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Chrysalis Center For Counseling And Eating Disorder Treatment PLLC (NPI 1891865218, Wilmington, NC), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2004
## Record status
- **NPPES last updated:** December 16, 2009
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Source: [NPI Profile](https://npiprofile.com/npi/1205025079) · Data from the CMS NPPES public registry.