KELLY R DOMENECH NP
NPI 1538048376
Nurse Practitioner - Psychiatric/Mental Health in Indianapolis, IN

Q: What is Kelly Domenech's NPI number?

The NPI number for Kelly Domenech is 1538048376. It was assigned to this individual provider in the NPPES registry on August 27, 2025.

Q: What is Kelly Domenech's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Domenech was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.

Active since August 27, 2025PECOS EnrolledAccepts Medicare Assignment

355 W 16TH ST STE 2800, INDIANAPOLIS, IN 46202(317) 963-7300(317) 963-7075 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kelly R Domenech Np NPPES

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

KELLY R DOMENECH NP (NPI 1538048376) is an individual psychiatric/mental health provider in Indianapolis, Indiana, licensed in Indiana (71017023A) and active in the NPI registry since August 2025. She is enrolled in Medicare PECOS, maintains a secondary practice location in Indianapolis, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1538048376

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKELLY R DOMENECHCredential: NP

Location Address355 W 16TH ST STE 2800Indianapolis, IN 46202-2279

Mailing Address355 W 16th St Ste 2800Indianapolis, IN 46202-2279 · (317) 963-7300 · Fax (317) 963-7075

Phone(317) 963-7300

Fax(317) 963-7075

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateAugust 27, 2025

Last NPPES UpdateSeptember 9, 2025

NPPES CertifiedSeptember 9, 2025

✔ NPI 1538048376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in IN · 71017023A

Also ListedNurse PractitionerTaxonomy 363L00000X · License 71017023A (IN)

355 W 16TH ST STE 2800, Indianapolis, IN 46202

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Secondary Practice Location 1

Location 1550 University BlvdIndianapolis, IN 46202-5149 · Phone (317) 944-5998

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly R Domenech Np 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 ID6305340142

PECOS Enrollment IDI20250916002732

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46202 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

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

Most-billed visit code 99214

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 20

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

RACHEL LYN GUNN

Psychologist (Clinical)