Dr Kelly M Gustavson-mattek, PSYD - Medicare Psychologist in Elkhorn, WI

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Dr Kelly M Gustavson-mattek, PSYD is a medicare enrolled "Psychologist" provider in Elkhorn, Wisconsin. Her current practice location is 1910 County Road Nn, Elkhorn, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (262) 741-3200.

Dr Kelly M Gustavson-mattek is licensed to practice in Wisconsin (license number 2533-057) 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 1750471314.

Contact Information

Dr Kelly M Gustavson-mattek, PSYD
1910 County Road Nn,
Elkhorn, WI 53121-4454
(262) 741-3200
(262) 741-3217

Map and Direction




Healthcare Provider's Profile

Full NameDr Kelly M Gustavson-mattek
GenderFemale
SpecialityPsychologist
Location1910 County Road Nn, Elkhorn, Wisconsin
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1750471314
  • Provider Enumeration Date: 10/13/2006
  • Last Update Date: 05/05/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 6901806769
  • Enrollment ID: I20070102000256

Medical Identifiers

Medical identifiers for Dr Kelly M Gustavson-mattek such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1750471314NPI-NPPES
40938700MedicaidWI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
103T00000XPsychologist 2533-057 (Wisconsin)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. Dr Kelly M Gustavson-mattek allows following entities to bill medicare on her behalf.
Entity NameCounty Of Walworth
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1588733307
PECOS PAC ID: 6002872835
Enrollment ID: O20041203000437

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. Dr Kelly M Gustavson-mattek 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
Dr Kelly M Gustavson-mattek, PSYD
Po Box 1005,
Elkhorn, WI 53121-1005

Ph: (262) 741-3200		Dr Kelly M Gustavson-mattek, PSYD
1910 County Road Nn,
Elkhorn, WI 53121-4454

Ph: (262) 741-3200

Reviews and Comments


Psychologist in Elkhorn, WI

Mrs. Vicki Ann Wahler, LPC
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 1 1/2 W Geneva St, Credence Therapy Associates, Elkhorn, WI 53121
Phone: 262-723-3424    Fax: 262-723-8308
Victoria S Loudon, PHD
Psychologist
Medicare: Not Enrolled in Medicare
Practice Location: 1 1/2 W Geneva St, Elkhorn, WI 53121
Phone: 262-723-3424    

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.