SHANE PITMAN KELLY DC
NPI 1710486832
Chiropractor in San Diego, CA
About Shane Pitman Kelly Dc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHANE PITMAN KELLY DC (NPI 1710486832) is an individual chiropractor in San Diego, California, licensed in California (DC34126) and active in the NPI registry since February 2018.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shane Pitman Kelly Dc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Shane Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Diego, CA 92108
- Reassigned Medicare billing, California enrollment
- 3 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 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN DIEGO, CA 92121
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 Shane Kelly's NPI number?
The NPI number for Shane Kelly is 1710486832. It was assigned to this individual provider in the NPPES registry on February 4, 2018.
Where is Shane Kelly located?
Shane Kelly practices at 10803 Vista Sorrento Pkwy, San Diego, CA 92121. The listed phone number is (197) 773-0196.
What is Shane Kelly's specialty?
The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.
Is Shane Kelly enrolled in Medicare?
Yes. Shane Kelly is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Shane Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shane Kelly reassigns Medicare benefits to Healcove, A Johnson Pontillas Chiropractic And Wellness PC (San Diego, CA). The 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 Shane 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 Shane Kelly was last updated on August 16, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Shane Pitman Kelly, DC · NPI 1710486832
Chiropractor provider in San Diego, California. Individual provider, active in the CMS NPPES registry since February 4, 2018.
## Identity
- **NPI:** 1710486832 (Entity type: Individual)
- **Enumerated:** February 4, 2018
- **Primary specialty:** Chiropractor · taxonomy 111N00000X
- **State license:** DC34126 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 10803 VISTA SORRENTO PKWY, San Diego, CA 92121-2792
- **Phone:** (197) 773-0196
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Healcove, A Johnson Pontillas Chiropractic And Wellness PC (NPI 1649971607, San Diego, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 16, 2019
- **Other identifiers:** Other DC34126 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1710486832) · Data from the CMS NPPES public registry.