KELLY JEAN GROSSMAN CNP
NPI 1629897160
Nurse Practitioner - Psychiatric/Mental Health in Saint Paul, MN

Q: What is Kelly Grossman's NPI number?

The NPI number for Kelly Grossman is 1629897160. It was assigned to this individual provider in the NPPES registry on October 9, 2024.

Q: What is Kelly Grossman'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 Grossman was last updated on October 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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 October 09, 2024PECOS Enrolled

2303 WYCLIFF ST STE W210, SAINT PAUL, MN 55114(612) 424-0434(877) 905-7069 Get Directions Write a Review

NPPES record last updated: October 9, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kelly Jean Grossman Cnp NPPES

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

KELLY JEAN GROSSMAN CNP (NPI 1629897160) is an individual psychiatric/mental health provider in Saint Paul, Minnesota, licensed in Minnesota (12166) and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS, maintains a secondary practice location in Chanhassen, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1629897160

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKELLY JEAN GROSSMANCredential: CNP

Location Address2303 WYCLIFF ST STE W210Saint Paul, MN 55114-1272

Mailing Address6204 Cascade PassChanhassen, MN 55317-9475 · (913) 645-7599

Phone(612) 424-0434

Fax(877) 905-7069

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateOctober 9, 2024

NPPES CertifiedOctober 9, 2024

✔ NPI 1629897160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

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

Taxonomy Code363LP0808X

License✔ Licensed in MN · 12166

2303 WYCLIFF ST STE W210, Saint Paul, MN 55114

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Secondary Practice Location 1

Location 16204 Cascade PassChanhassen, MN 55317-9475 · Phone (913) 645-7599

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Jean Grossman Cnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5890220784

PECOS Enrollment IDI20241202002750

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 55114 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

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

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 6

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

CAROLINE LYNN SOON STARK MSW, LICSW

Social Worker (Clinical)