JACQUELINE KELLY
NPI 1235077694
Nurse Practitioner - Family in Lakeport, CA
About Jacqueline Kelly NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACQUELINE KELLY (NPI 1235077694) is an individual family provider in Lakeport, California, licensed in California (F02260054) and active in the NPI registry since March 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses
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
Jacqueline Kelly 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 Jacqueline Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lakeport, CA 95453
- Reassigned Medicare billing, California enrollment
- 132 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 95453 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
LAKEPORT, CA 95453
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 Jacqueline Kelly's NPI number?
The NPI number for Jacqueline Kelly is 1235077694. It was assigned to this individual provider in the NPPES registry on March 24, 2026.
Where is Jacqueline Kelly located?
Jacqueline Kelly practices at 925 Bevins Ct, Lakeport, CA 95453. The listed phone number is (707) 263-8382.
What is Jacqueline Kelly's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Jacqueline Kelly enrolled in Medicare?
Yes. Jacqueline Kelly 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 Jacqueline Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacqueline Kelly reassigns Medicare benefits to Sutter Bay Hospitals (Lakeport, 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 Jacqueline Kelly'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 Jacqueline Kelly was last updated on March 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Jacqueline Kelly · NPI 1235077694
Family physician in Lakeport, California. Individual provider, active in the CMS NPPES registry since March 24, 2026.
## Identity
- **NPI:** 1235077694 (Entity type: Individual)
- **Enumerated:** March 24, 2026
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** F02260054 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 925 BEVINS CT, Lakeport, CA 95453-9754
- **Phone:** (707) 263-8382
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Sutter Bay Hospitals (NPI 1770816829, Lakeport, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** March 24, 2026
---
Source: [NPI Profile](https://npiprofile.com/npi/1235077694) · Data from the CMS NPPES public registry.