ROBERTA RIDYN KELLEY LMFT
NPI 1538831987
Marriage & Family Therapist in Plymouth, MN
About Roberta Ridyn Kelley Lmft NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ROBERTA RIDYN KELLEY LMFT (NPI 1538831987) is an individual marriage & family therapist in Plymouth, Minnesota, licensed in Minnesota (4461) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 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
Roberta Ridyn Kelley Lmft 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 Roberta Kelley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Anoka, MN 55303
- Reassigned Medicare billing, Minnesota enrollment
- 145 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 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PLYMOUTH, MN 55447
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 Roberta Kelley's NPI number?
The NPI number for Roberta Kelley is 1538831987. It was assigned to this individual provider in the NPPES registry on October 4, 2021.
Where is Roberta Kelley located?
Roberta Kelley practices at 3007 Harbor Ln N Ste 1600, Plymouth, MN 55447. The listed phone number is (612) 915-0049.
What is Roberta Kelley's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Roberta Kelley enrolled in Medicare?
Yes. Roberta Kelley 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 Roberta Kelley's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Roberta Kelley reassigns Medicare benefits to Family Innovations, Inc. (Anoka, MN). 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 Roberta Kelley'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 Roberta Kelley was last updated on June 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Roberta Ridyn Kelley, LMFT · NPI 1538831987
Marriage & Family Therapist provider in Plymouth, Minnesota. Individual provider, active in the CMS NPPES registry since October 4, 2021.
## Identity
- **NPI:** 1538831987 (Entity type: Individual)
- **Enumerated:** October 4, 2021
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** 4461 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 3007 HARBOR LN N STE 1600, Plymouth, MN 55447-5142
- **Phone:** (612) 915-0049
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Family Innovations, Inc. (NPI 1992862783, Anoka, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** June 12, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1538831987) · Data from the CMS NPPES public registry.