DR. JEFF KELLY PSY.D.
NPI 1669631065
Psychologist in Crescent City, CA

Active since June 02, 2008PECOS EnrolledAccepts Medicare Assignment
1080 MASON MALL STE 6C, CRESCENT CITY, CA 95531(707) 951-7620 Get Directions Write a Review

NPPES record last updated: February 7, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Jeff Kelly Psy.d. NPPES

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

DR. JEFF KELLY PSY.D. (NPI 1669631065) is an individual psychologist in Crescent City, California, licensed in California (PSY20204) and active in the NPI registry since June 2008. He is enrolled in Medicare PECOS and is a graduate of Other (2001).

NPPES Registry Identity

NPI1669631065
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. JEFF KELLYCredential: PSY.D.
Location Address1080 MASON MALL STE 6CCrescent City, CA 95531-4335
Mailing Address5905 Lake Earl DrCrescent City, CA 95532-0001 · (707) 465-1000
Sole ProprietorYes
Medical School CMSOtherGraduated 2001
Enumeration DateJune 2, 2008
Last NPPES UpdateFebruary 7, 2020
✔ NPI 1669631065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in CA · PSY20204
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
1080 MASON MALL STE 6C, Crescent City, CA 95531

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

Dr. Jeff Kelly Psy.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 ID8426475716
PECOS Enrollment IDI20200901002800
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 Reassignments

2

Medicare enrollment records show Jeff Kelly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Psychologist
1080 MASON MALL STE 6C
Crescent City, CA 95531
  • Reassigned Medicare billing, California enrollment
Addiction Medicine
4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054
  • Reassigned Medicare billing, California enrollment
  • 1,607 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.

Other Providers at the Same Location NPPES 3

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

Prosthetic/Orthotic Supplier
1080 MASON MALL STE 6C
CRESCENT CITY, CA 95531
Psychologist
1080 MASON MALL STE 6C
CRESCENT CITY, CA 95531
Prosthetic/Orthotic Supplier
1080 MASON MALL STE 6C
CRESCENT CITY, CA 95531

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 Jeff Kelly's NPI number?

The NPI number for Jeff Kelly is 1669631065. It was assigned to this individual provider in the NPPES registry on June 2, 2008.

Where is Jeff Kelly located?

Jeff Kelly practices at 1080 Mason Mall Ste 6C, Crescent City, CA 95531. The listed phone number is (707) 951-7620.

What is Jeff Kelly's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Jeff Kelly enrolled in Medicare?

Yes. Jeff 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 Jeff Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jeff Kelly reassigns Medicare benefits to 2 organizations: Redwood Psychological, Inc (Crescent City, CA) and Sud Specialty Group - Ca (Santa Clara, 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 Jeff Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jeff Kelly was last updated on February 7, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.