KELLY A BUSHUR CP PH.D
NPI 1629248406
Psychologist - Clinical in Carbondale, IL

Active since March 07, 2008PECOS EnrolledAccepts Medicare Assignment
400 S LEWIS LN, CARBONDALE, IL 62901(618) 519-9900(618) 529-1384 Get Directions Write a Review

NPPES record last updated: October 23, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kelly A Bushur Cp Ph.d NPPES

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

KELLY A BUSHUR CP PH.D (NPI 1629248406) is an individual clinical provider in Carbondale, Illinois, licensed in Illinois (071005772) and active in the NPI registry since March 2008. She is enrolled in Medicare PECOS and is a graduate of Other (1996).

NPPES Registry Identity

NPI1629248406
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameKELLY A BUSHURCredential: CP PH.D
Location Address400 S LEWIS LNCarbondale, IL 62901-3547
Mailing AddressPo Box 577Carterville, IL 62918-0577 · (618) 985-8221 · Fax (618) 985-6860
Fax(618) 529-1384
Sole ProprietorNo
Medical School CMSOtherGraduated 1996
Enumeration DateMarch 7, 2008
Last NPPES UpdateOctober 23, 2014
NPI 1629248406 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License Licensed in IL · 071005772
Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

400 S LEWIS LN, Carbondale, IL 62901

Other Names 1

Former Name (1)Kelly A Rhodes Cp Ph.d

Other Identifiers 11

Medicaid370966854024IL
Medicaid370966854015IL
Medicare OSCAR/certification141840IL
Medicaid370966854006IL
Medicare OSCAR/certification141848IL
Medicare OSCAR/certification141112IL
Medicaid370966854002IL
Medicare OSCAR/certification141016IL
Other640701IL · Medicare Group Id
Medicaid370966854005IL
Medicare OSCAR/certification141849IL

Accepted Insurance

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 A Bushur Cp Ph.d 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 ID3577746197
PECOS Enrollment IDI20141001000447
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 62901 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
$168.44 typical visit price
range $54.80 – $168.44
Typical copayment $42.11 (range $13.70 – $42.11)
Most-billed visit code 99205
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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 16

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

Counselor (Mental Health)
400 S LEWIS LN
CARBONDALE, IL 62901
Clinic/Center (Federally Qualified Health Center (FQHC))
400 S LEWIS LN
CARBONDALE, IL 62901
Physician Assistant
400 S LEWIS LN
CARBONDALE, IL 62901
Clinical Medical Laboratory
400 S LEWIS LN
CARBONDALE, IL 62901
Nurse Practitioner (Family)
400 S LEWIS LN
CARBONDALE, IL 62901
Counselor (Mental Health)
400 S LEWIS LN
CARBONDALE, IL 62901
Counselor (Mental Health)
400 S LEWIS LN
CARBONDALE, IL 62901
Physician Assistant
400 S LEWIS LN
CARBONDALE, IL 62901

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 Bushur's NPI number?

The NPI number for Kelly Bushur is 1629248406. It was assigned to this individual provider in the NPPES registry on March 7, 2008. The provider is also known as Kelly A Rhodes Cp Ph.D.

Where is Kelly Bushur located?

Kelly Bushur practices at 400 S Lewis Ln, Carbondale, IL 62901. The listed phone number is (618) 519-9900.

What is Kelly Bushur's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Kelly Bushur enrolled in Medicare?

Yes. Kelly Bushur 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.

What insurance does Kelly Bushur accept?

Health plans from Medica and Oscar Insurance Company list Kelly Bushur 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 Bushur was last updated on October 23, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.