LISA M GONDEK KELLY CRNA
NPI 1720061203
Nurse Anesthetist, Certified Registered in Greenville, SC

Q: What is Lisa Gondek Kelly's NPI number?

The NPI number for Lisa Gondek Kelly is 1720061203. It was assigned to this individual provider in the NPPES registry on November 29, 2005. The provider is also known as Lisa M Kelly Crna.

Q: What is Lisa Gondek Kelly's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Gondek Kelly was last updated on January 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since November 29, 2005Accepts Medicare Assignment

7 INDEPENDENCE PT STE 300, GREENVILLE, SC 29615(864) 522-3700(864) 522-3705 Get Directions Write a Review

NPPES record last updated: January 20, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Lisa M Gondek Kelly Crna NPPES

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

LISA M GONDEK KELLY CRNA (NPI 1720061203) is an individual nurse anesthetist, certified registered in Greenville, South Carolina, licensed in South Carolina (525) and active in the NPI registry since November 2005. She is affiliated with Prisma Health Oconee Memorial Hospital, maintains a secondary practice location in Seneca, and is a graduate of University Of Wisconsin School Of Medicine (2000).

NPPES Registry Identity

NPI1720061203

Entity TypeIndividualFemale

Primary Taxonomy367500000X

Provider Legal NameLISA M GONDEK KELLYCredential: CRNA

Location Address7 INDEPENDENCE PT STE 300Greenville, SC 29615-4569

Mailing Address300 E Mcbee Ave, Fl 4Greenville, SC 29601-2842 · (864) 522-8603

Phone(864) 522-3700

Fax(864) 522-3705

Sole ProprietorNo

Medical School CMSUniversity Of Wisconsin School Of MedicineGraduated 2000

Enumeration DateNovember 29, 2005

Last NPPES UpdateJanuary 20, 2022

NPPES CertifiedJanuary 20, 2022

✔ NPI 1720061203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in SC · 525

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

7 INDEPENDENCE PT STE 300, Greenville, SC 29615

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Other Names 1

Professional Name (2)Lisa M Kelly Crna

Secondary Practice Location 1

Location 1298 Memorial DrSeneca, SC 29672-9443 · Phone (864) 882-3351 · Fax (864) 885-7619

Other Identifiers 4

MedicaidGP2991SC

Other400097SC · Medicaid - Group

MedicaidAN0929SC

Other1152SC · Medicare - Group

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

Lisa M Gondek Kelly Crna 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 ID4385681824

PECOS Enrollment IDI20050415000133

Medicare Billing Reassignments

Medicare enrollment records show Lisa Gondek Kelly reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Prisma Health University Medical Group

0.8 mi

Internal Medicine

1025 VERDAE BLVD, SUITE A
Greenville, SC 29607

Reassigned Medicare billing, South Carolina enrollment
3,281 clinicians in this Medicare group

NPI 1083787006 (864) 242-4683

Prisma Health-Upstate

0.8 mi

Sleep Disorder Diagnostic

1025 VERDAE BLVD, SUITE D
Greenville, SC 29607

Reassigned Medicare billing, South Carolina enrollment
413 clinicians in this Medicare group

NPI 1275086431 (864) 455-7743

Greenville Health System

1.6 mi

General Acute Care Hospital

200 PATEWOOD DR, SUITE C 300
Greenville, SC 29615

Reassigned Medicare billing, South Carolina enrollment
735 clinicians in this Medicare group

NPI 1184049041 (864) 454-8272

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Prisma Health Oconee Memorial Hospital

Acute Care Hospitals · Seneca, SC

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number420009

Location298 Memorial DrSeneca, SC 29672 · Oconee County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29615 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

$124.04 typical visit price

range $53.57 – $163.84

Typical copayment $31.01 (range $13.39 – $40.96)

Most-billed visit code 99204

Established Patient

$67.12 typical visit price

range $16.96 – $133.52

Typical copayment $16.78 (range $4.24 – $33.38)

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.

PAUL DEREK STREET CRNA

Nurse Anesthetist, Certified Registered