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DR. KELLY CARROTHERS MANTEI DDS
NPI 1508876566
Dentist - General Practice in St Augustine, FL

Active since August 09, 2006Opted out of Medicare · through Feb 22, 2028
2225 A1A S STE A3, ST AUGUSTINE, FL 32080(904) 471-7300(904) 471-2708 Get Directions Write a Review

NPPES record last updated: May 9, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Kelly Carrothers Mantei Dds NPPES

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

DR. KELLY CARROTHERS MANTEI DDS (NPI 1508876566) is an individual general practice provider in St Augustine, Florida, licensed in Florida (DN15067) and active in the NPI registry since August 2006. She has opted out of Medicare through February 22, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1508876566
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KELLY CARROTHERS MANTEICredential: DDS
Location Address2225 A1A S STE A3St Augustine, FL 32080-6374
Mailing Address2225 A1a S Ste A3St Augustine, FL 32080-6374 · (904) 471-7300
Phone(904) 471-7300
Fax(904) 471-2708
Sole ProprietorNo
Enumeration DateAugust 9, 2006
Last NPPES UpdateMay 9, 2016
✔ NPI 1508876566 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in FL · DN15067
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2225 A1A S STE A3, St Augustine, FL 32080
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Other Names 1

Other Name (5)Mrs. Kelly Carrothers Mantei

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, BEST Life and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Dr. Kelly Carrothers Mantei Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 22, 2016 through February 22, 2028.

Opt-Out Effective DateFebruary 22, 2016
Opt-Out In Effect ThroughFebruary 22, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32080 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

PROFESSIONAL DENTAL ALLIANCE OF ST. AUGUSTINE, PLLC
Dentist (General Practice)
2225 A1A S STE A3
ST AUGUSTINE, FL 32080
St. Johns County (904) 201-3442
MICHELLE DEFELICE
Dentist
2225 A1A S STE A3
ST AUGUSTINE, FL 32080
St. Johns County (904) 471-7300
ST. JOHNS FAMILY DENTISTRY
Dentist
2225 A1A S STE A3
ST AUGUSTINE, FL 32080
St. Johns County (904) 471-7300

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 Mantei's NPI number?

The NPI number for Kelly Mantei is 1508876566. It was assigned to this individual provider in the NPPES registry on August 9, 2006. The provider is also known as Mrs. Kelly Carrothers Mantei.

Where is Kelly Mantei located?

Kelly Mantei practices at 2225 A1a S Ste A3, St Augustine, FL 32080. The listed phone number is (904) 471-7300.

What is Kelly Mantei's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Kelly Mantei enrolled in Medicare?

No. Kelly Mantei has opted out of Medicare through February 22, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Kelly Mantei accept?

Health plans from Ambetter Health, Ambetter of Alabama, BEST Life, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 9 other insurers list Kelly Mantei 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 Mantei was last updated on May 9, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.