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KELLY GRACE SHAW MS, LPC, NCC
NPI 1962068650
Counselor in Eugene, OR

Active since May 17, 2019PECOS Enrolled
770 E 11TH AVE FL SSB2, EUGENE, OR 97401(458) 205-7085(458) 205-7089 Get Directions Write a Review

NPPES record last updated: November 14, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 14, 2023, May 5, 2022, May 17, 2019 (3 updates tracked since 2019).

About Kelly Grace Shaw Ms, Lpc, Ncc NPPES

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

KELLY GRACE SHAW MS, LPC, NCC (NPI 1962068650) is an individual counselor in Eugene, Oregon and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1962068650
Entity TypeIndividualFemale
Primary Taxonomy101Y00000X
Provider Legal NameKELLY GRACE SHAWCredential: MS, LPC, NCC
Location Address770 E 11TH AVE FL SSB2Eugene, OR 97401-3746
Mailing AddressPo Box 18Vida, OR 97488-0018 · (541) 771-1017
Phone(458) 205-7085
Fax(458) 205-7089
Sole ProprietorNo
Enumeration DateMay 17, 2019
Last NPPES UpdateNovember 14, 20233 updates tracked since enumeration
NPPES CertifiedNovember 14, 2023
✔ NPI 1962068650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
770 E 11TH AVE FL SSB2, Eugene, OR 97401
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1175 W B StSpringfield, OR 97477-4575 · Phone (541) 762-1971
Location 254771 McKenzie HwyBlue River, OR 97413-9790 · Phone (541) 771-1017

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. 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)

Kelly Grace Shaw Ms, Lpc, Ncc 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 Kelly Shaw reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Peacehealth Medical Group
0.1 mi
Family Medicine
1200 HILYARD ST
Eugene, OR 97401
  • Reassigned Medicare billing, Oregon enrollment
  • 412 clinicians in this Medicare group
NPI 1447207287 (541) 687-6217

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

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 Kelly Shaw's NPI number?

The NPI number for Kelly Shaw is 1962068650. It was assigned to this individual provider in the NPPES registry on May 17, 2019.

Where is Kelly Shaw located?

Kelly Shaw practices at 770 E 11th Ave Fl Ssb2, Eugene, OR 97401. The listed phone number is (458) 205-7085.

What is Kelly Shaw's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Kelly Shaw enrolled in Medicare?

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

Which organization bills Medicare for Kelly Shaw's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Shaw reassigns Medicare benefits to Peacehealth Medical Group (Eugene, OR). 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 Kelly Shaw's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Shaw accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Kelly Shaw 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 Kelly Shaw was last updated on November 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.