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

Q: 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.

Q: What is Tatiana Kelley's specialty?

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

Q: 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 23 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 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: November 08, 2026.

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

On this page

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

Open in Google Maps ↗

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

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.

Medicare Billing Reassignment

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

Dignity Health Medical Foundation

0.3 mi

Multi-Specialty

7911 LAGUNA BLVD
Elk Grove, CA 95758

Reassigned Medicare billing, California enrollment
1,191 clinicians in this Medicare group

NPI 1558495937 (916) 733-5801

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 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)