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HOLLY R. KELLY N.P.
NPI 1750630786
Nurse Practitioner in Plymouth, IN

Active since September 06, 2012PECOS Enrolled
2855 MILLER DR STE 121B, PLYMOUTH, IN 46563(574) 522-0265(574) 406-0025 Get Directions Write a Review

NPPES record last updated: May 14, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Holly R. Kelly N.p. NPPES

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

HOLLY R. KELLY N.P. (NPI 1750630786) is an individual nurse practitioner in Plymouth, Indiana, licensed in Indiana (71004121A) and active in the NPI registry since September 2012. She is enrolled in Medicare PECOS and maintains a secondary practice location in Elkhart.

NPPES Registry Identity

NPI1750630786
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameHOLLY R. KELLYCredential: N.P.
Location Address2855 MILLER DR STE 121BPlymouth, IN 46563-8091
Mailing Address211 N Eddy StSouth Bend, IN 46617-2808 · (574) 237-9231 · Fax (574) 204-6355
Phone(574) 522-0265
Fax(574) 406-0025
Sole ProprietorNo
Enumeration DateSeptember 6, 2012
Last NPPES UpdateMay 14, 2026
NPPES CertifiedMay 14, 2026
✔ NPI 1750630786 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in IN · 71004121A
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
2855 MILLER DR STE 121B, Plymouth, IN 46563
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Other Names 1

Former Name (1)Holly R. Sucharetza

Secondary Practice Location 1

Location 1111 N Nappanee StElkhart, IN 46514-1957 · Phone (574) 522-0265 · Fax (574) 406-0025

Other Identifiers 1

Medicaid201092360IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Holly R. Kelly N.p. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Holly Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dermatology & Skin Surgery Center
89 mi
Specialist
7070 E DR N
Battle Creek, MI 49014
  • Reassigned Medicare billing, Indiana enrollment
  • 9 clinicians in this Medicare group
NPI 1083649628 (269) 660-1670

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 46563 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
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Holly Kelly's NPI number?

The NPI number for Holly Kelly is 1750630786. It was assigned to this individual provider in the NPPES registry on September 6, 2012. The provider is also known as Holly R. Sucharetza.

Where is Holly Kelly located?

Holly Kelly practices at 2855 Miller Dr Ste 121B, Plymouth, IN 46563. The listed phone number is (574) 522-0265.

What is Holly Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Holly Kelly enrolled in Medicare?

Yes. Holly Kelly is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Holly Kelly's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Holly Kelly reassigns Medicare benefits to Dermatology & Skin Surgery Center (Battle Creek, MI). 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 Holly Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Holly Kelly accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource and Priority Health list Holly 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 Holly Kelly was last updated on May 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.