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KELLY RICHARDSON MD05/
NPI 1548278971
Internal Medicine - Adolescent Medicine in Wyoming, MI

Active since August 03, 2006PECOS Enrolled
1200 56TH ST SW, WYOMING, MI 49509(616) 243-5707(616) 243-1170 Get Directions Write a Review

NPPES record last updated: October 18, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Kelly Richardson Md05/ NPPES

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

KELLY RICHARDSON MD05/ (NPI 1548278971) is an individual adolescent medicine provider in Wyoming, Michigan, licensed in Michigan (4301079769) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS and is a graduate of Michigan State University College Of Human Medicine (2002).

NPPES Registry Identity

NPI1548278971
Entity TypeIndividualFemale
Primary Taxonomy207RA0000X
Provider Legal NameKELLY RICHARDSONCredential: MD05/
Location Address1200 56TH ST SWWyoming, MI 49509-9704
Mailing Address1200 56th St SwWyoming, MI 49509-9704 · (616) 243-5707 · Fax (616) 243-1170
Phone(616) 243-5707
Fax(616) 243-1170
Sole ProprietorNo
Medical School CMSMichigan State University College Of Human MedicineGraduated 2002
Enumeration DateAugust 3, 2006
Last NPPES UpdateOctober 18, 2011
✔ NPI 1548278971 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RA0000X
License✔ Licensed in MI · 4301079769
Definition
An internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Also ListedInternal MedicineTaxonomy 207R00000X · License 4301079769 (MI)
1200 56TH ST SW, Wyoming, MI 49509
Open in Google Maps ↗

Other Identifiers 3

Medicare UPINI64617
Other381360529MI · Tax Id
Medicare PINP25800003

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Richardson Md05/ is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4789683053
PECOS Enrollment IDI20061214000167
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.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Richardson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Brookville Pediatric & Internal Medicine, PC
Same address
Pediatrics
1200 56TH ST SW
Wyoming, MI 49509
  • Reassigned Medicare billing, Michigan enrollment
  • 4 clinicians in this Medicare group
NPI 1346200847 (616) 243-5707

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 9

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

HANNAH GAGNEUR
Technician/Technologist
1200 56TH ST SW
WYOMING, MI 49509
Kent County (269) 312-0365
DR. JANET F JOHNS M.D.
Pediatrics
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 514-3803
DR. REBECCA L. MAKI M.D.
Pediatrics
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707
DR. JAMIE D. BOSCH M.D.
Pediatrics
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707
BROOKVILLE PEDIATRIC & INTERNAL MEDICINE, PC
Pediatrics
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707
MRS. LINNELLE ANNE VELDHOUSE MD
Internal Medicine
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707
DR. DWAYNE L.. COOK M.D.
Internal Medicine
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707
DR. JENIFER K.. YOUNGS D.O.
Pediatrics
1200 56TH ST SW
WYOMING, MI 49509
Kent County (616) 243-5707

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 Richardson's NPI number?

The NPI number for Kelly Richardson is 1548278971. It was assigned to this individual provider in the NPPES registry on August 3, 2006.

Where is Kelly Richardson located?

Kelly Richardson practices at 1200 56th St SW, Wyoming, MI 49509. The listed phone number is (616) 243-5707.

What is Kelly Richardson's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Adolescent Medicine, with taxonomy code 207RA0000X.

Is Kelly Richardson enrolled in Medicare?

Yes. Kelly Richardson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kelly Richardson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Richardson reassigns Medicare benefits to Brookville Pediatric & Internal Medicine, PC (Wyoming, MI). 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 Kelly Richardson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Richardson accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health and UnitedHealthcare list Kelly Richardson 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 Richardson was last updated on October 18, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.