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TATIANA SIMONE KELLEY MD
NPI 1902480445
Family Medicine in Elk Grove, CA

Active since May 11, 2021PECOS EnrolledAccepts Medicare Assignment
9394 BIG HORN BLVD, ELK GROVE, CA 95758(916) 691-8500(916) 691-8589 Get Directions Write a Review

NPPES record last updated: December 3, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 3, 2024, May 11, 2021 (2 updates tracked since 2021).

About Tatiana Simone Kelley Md NPPES

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

TATIANA SIMONE KELLEY MD (NPI 1902480445) is an individual family medicine provider in Elk Grove, California, licensed in California (A191453) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS and is a graduate of Southern Illinois University School Of Medicine (2020).

NPPES Registry Identity

NPI1902480445
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameTATIANA SIMONE KELLEYCredential: MD
Location Address9394 BIG HORN BLVDElk Grove, CA 95758-7977
Mailing Address3400 Data DrRancho Cordova, CA 95670-7956
Phone(916) 691-8500
Fax(916) 691-8589
Sole ProprietorNo
Medical School CMSSouthern Illinois University School Of MedicineGraduated 2020
Enumeration DateMay 11, 2021
Last NPPES UpdateDecember 3, 20242 updates tracked since enumeration
NPPES CertifiedDecember 3, 2024
✔ NPI 1902480445 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A191453
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
9394 BIG HORN BLVD, Elk Grove, CA 95758
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tatiana Simone Kelley Md 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 ID3577099878
PECOS Enrollment IDI20241210003431
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95758 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
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
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.

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.

AZADEH TOOFANINEJAD D.O.
Internal Medicine (Cardiovascular Disease)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 961-8500
NAVJOT KAUR DHILLON FNP
Nurse Practitioner (Family)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500
JOAN BIANCA ROBERTS MD
Family Medicine
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500
MS. PATRICIA A WALLRICH PA-C
Physician Assistant
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8524
JULIA T TIAN M.D.
Internal Medicine (Cardiovascular Disease)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500
DR. CATHARINE MALMSTEN M.D.
Internal Medicine (Cardiovascular Disease)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500
MRS. ANN P NGUYEN NP
Nurse Practitioner (Adult Health)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500
LUE LAO MD
Internal Medicine (Cardiovascular Disease)
9394 BIG HORN BLVD
ELK GROVE, CA 95758
Sacramento County (916) 691-8500

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 Tatiana Kelley's NPI number?

The NPI number for Tatiana Kelley is 1902480445. It was assigned to this individual provider in the NPPES registry on May 11, 2021.

Where is Tatiana Kelley located?

Tatiana Kelley practices at 9394 Big Horn Blvd, Elk Grove, CA 95758. The listed phone number is (916) 691-8500.

What is Tatiana Kelley's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Tatiana Kelley enrolled in Medicare?

Yes. Tatiana Kelley 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.

When was this NPI record last updated?

The NPPES record for Tatiana Kelley was last updated on December 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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.