KATHLEEN G CONNELLY DMD
NPI 1710877360
Dentist - General Practice in Louisville, KY

Q: What is Kathleen Connelly's NPI number?

The NPI number for Kathleen Connelly is 1710877360. It was assigned to this individual provider in the NPPES registry on July 7, 2025.

Q: What is Kathleen Connelly's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Kathleen Connelly was last updated on July 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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 July 07, 2025PECOS Enrolled

3015 WILSON AVE, LOUISVILLE, KY 40211(502) 774-4401 Get Directions Write a Review

NPPES record last updated: July 7, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Kathleen G Connelly Dmd NPPES

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

KATHLEEN G CONNELLY DMD (NPI 1710877360) is an individual general practice provider in Louisville, Kentucky, licensed in Kentucky (11369) and active in the NPI registry since July 2025. She is enrolled in Medicare PECOS and is a graduate of University Of Louisville School Of Dentistry (2025).

NPPES Registry Identity

NPI1710877360

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameKATHLEEN G CONNELLYCredential: DMD

Location Address3015 WILSON AVELouisville, KY 40211-1969

Mailing Address3015 Wilson AveLouisville, KY 40211-1969 · (502) 774-4401

Phone(502) 774-4401

Sole ProprietorNo

Medical School CMSUniversity Of Louisville School Of DentistryGraduated 2025

Enumeration DateJuly 7, 2025

NPPES CertifiedJuly 7, 2025

✔ NPI 1710877360 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in KY · 11369

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

3015 WILSON AVE, Louisville, KY 40211

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter of Tennessee and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kathleen G Connelly Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991262552

PECOS Enrollment IDI20260804003450

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 Reassignment

Medicare enrollment records show Kathleen Connelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Park Duvalle Community Health Center, Inc.

Same address

Federally Qualified Health Center (FQHC)

3015 WILSON AVE
Louisville, KY 40211

Reassigned Medicare billing, Kentucky enrollment
22 clinicians in this Medicare group

NPI 1245253160 (502) 774-4401

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 40211 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

$82.24 typical visit price

range $52.76 – $162.27

Typical copayment $20.56 (range $13.19 – $40.56)

Most-billed visit code 99203

Established Patient

$66.24 typical visit price

range $16.53 – $131.99

Typical copayment $16.56 (range $4.13 – $32.99)

Most-billed visit code 99213

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 20

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

NIKEEA BULLOCK APRN

Nurse Practitioner (Psychiatric/Mental Health)