Kelly Susan Davis, - Medicare Counselor in San Rafael, CA

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Kelly Susan Davis, is a medicare enrolled "Counselor - Mental Health" provider in San Rafael, California. Her current practice location is 900 5th Ave, Suite 150, San Rafael, California. You can reach out to her office (for appointments etc.) via phone at (415) 457-6964.

Kelly Susan Davis is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1093143554.

Contact Information

Kelly Susan Davis,
900 5th Ave, Suite 150,
San Rafael, CA 94901-2959
(415) 457-6964
Not Available

Map and Direction


Healthcare Provider's Profile

Full NameKelly Susan Davis
GenderFemale
SpecialityCounselor - Mental Health
Location900 5th Ave, San Rafael, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1093143554
  • Provider Enumeration Date: 10/21/2013
  • Last Update Date: 03/10/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 7618499195
  • Enrollment ID: I20250313004076

Medical Identifiers

Medical identifiers for Kelly Susan Davis such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1093143554NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
106H00000XMarriage & Family Therapist MT5113 (Florida)Secondary
101YM0800XCounselor - Mental Health (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Susan Davis allows following entities to bill medicare on her behalf.
Entity NameQuality Bhs Florida Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1689297541
PECOS PAC ID: 4082030721
Enrollment ID: O20200812002561
Entity NameTelos Health Systems Fl Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1801624242
PECOS PAC ID: 6901329556
Enrollment ID: O20250325001658

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Susan Davis is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kelly Susan Davis,
900 5th Ave, Suite 150,
San Rafael, CA 94901-2959

Ph: (415) 457-6964		Kelly Susan Davis,
900 5th Ave, Suite 150,
San Rafael, CA 94901-2959

Ph: (415) 457-6964

Reviews and Comments


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Phone: 415-444-5580    Fax: 415-444-5598

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.