KIM MY KELLY OD
NPI 1629963459
Optometrist in Chula Vista, CA
About Kim My Kelly Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KIM MY KELLY OD (NPI 1629963459) is an individual optometrist in Chula Vista, California, licensed in California (36002) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS and is a graduate of Southern California College Of Optometry (2025).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
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
Kim My Kelly Od 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 Reassignments
2Medicare enrollment records show Kim Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Chula Vista, CA 91910
- Reassigned Medicare billing, California enrollment
- 11 clinicians in this Medicare group
San Diego, CA 92128
- Reassigned Medicare billing, California enrollment
- 236 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91910 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 10
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Kim Kelly's NPI number?
The NPI number for Kim Kelly is 1629963459. It was assigned to this individual provider in the NPPES registry on June 11, 2025.
Where is Kim Kelly located?
Kim Kelly practices at 342 F St, Chula Vista, CA 91910. The listed phone number is (619) 422-1471.
What is Kim Kelly's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Kim Kelly enrolled in Medicare?
Yes. Kim Kelly 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 organizations bill Medicare for Kim Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kim Kelly reassigns Medicare benefits to 2 organizations: Castillejos Eye Institute Medical Group (Chula Vista, CA) and Total Vision PC (San Diego, CA). Each 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 Kim Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kim Kelly accept?
Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Providence Health Plan list Kim Kelly 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 Kim Kelly was last updated on June 11, 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.
# Kim My Kelly, OD · NPI 1629963459
Optometrist provider in Chula Vista, California. Individual provider, active in the CMS NPPES registry since June 11, 2025.
## Identity
- **NPI:** 1629963459 (Entity type: Individual)
- **Enumerated:** June 11, 2025
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 36002 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 342 F ST, Chula Vista, CA 91910-2625
- **Phone:** (619) 422-1471
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Castillejos Eye Institute Medical Group (NPI 1841377660, Chula Vista, CA); Total Vision PC (NPI 1356813711, San Diego, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Southern California College Of Optometry, class of 2025
## Record status
- **NPPES last updated:** June 11, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1629963459) · Data from the CMS NPPES public registry.