KELLY SHOUSE FNP-C
NPI 1619706041
Nurse Practitioner - Family in Modesto, CA

Q: What is Kelly Shouse's NPI number?

The NPI number for Kelly Shouse is 1619706041. It was assigned to this individual provider in the NPPES registry on August 1, 2024.

Q: What is Kelly Shouse's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Shouse was last updated on August 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 01, 2024PECOS Enrolled

1224 SCENIC DR, MODESTO, CA 95350(209) 442-6077(833) 573-2336 Get Directions Write a Review

NPPES record last updated: August 28, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 28, 2026, Aug 13, 2024, Aug 1, 2024 (3 updates tracked since 2024).

On this page

About Kelly Shouse Fnp-c NPPES

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

KELLY SHOUSE FNP-C (NPI 1619706041) is an individual family provider in Modesto, California, licensed in California (95030512) and active in the NPI registry since August 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619706041

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY SHOUSECredential: FNP-C

Location Address1224 SCENIC DRModesto, CA 95350-6137

Mailing Address1224 Scenic DrModesto, CA 95350-6137 · (209) 442-6077 · Fax (833) 573-2336

Phone(209) 442-6077

Fax(833) 573-2336

Sole ProprietorNo

Enumeration DateAugust 1, 2024

Last NPPES UpdateAugust 28, 20263 updates tracked since enumeration

NPPES CertifiedAugust 28, 2026

✔ NPI 1619706041 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95030512

1224 SCENIC DR, Modesto, CA 95350

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Shouse Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Shouse reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Lumira Healthcare

1.4 mi

Federally Qualified Health Center (FQHC)

2116 E. ORANGEBURG AVE.
Modesto, CA 95355

Reassigned Medicare billing, California enrollment
Medicare enrollment name: Livingston Community Health
38 clinicians in this Medicare group

NPI 1760191811 (209) 850-3500

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 95350 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

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$103.36 typical visit price

range $19.28 – $144.60

Typical copayment $25.84 (range $4.82 – $36.15)

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 8

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

SUKHJIT SAMRA M.D.

Family Medicine