Crystal Dianne Kellam, MSW is a medicare enrolled "Social Worker - Clinical" provider in Greenville, North Carolina. She graduated from healthcare school in 2018 and has 7 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice East Carolina University and her current practice location is
905 Johns Hopkins Dr, Greenville, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(252) 744-1406.
Crystal Dianne Kellam is licensed to practice in North Carolina (license number C013218) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1265084800.
Healthcare Provider's Profile
Full Name | Crystal Dianne Kellam |
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Gender | Female |
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Speciality | Clinical Social Worker |
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Experience | 7 Years |
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Location | 905 Johns Hopkins Dr, Greenville, North Carolina |
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Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Crystal Dianne Kellam graduated from medical school in 2018
NPI Data:
- NPI Number: 1265084800
- Provider Enumeration Date: 07/14/2019
- Last Update Date: 02/15/2024
Medicare PECOS Information:
- PECOS PAC ID: 2860810777
- Enrollment ID: I20200909001927
Medical Identifiers
Medical identifiers for Crystal Dianne Kellam such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1265084800 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YA0400X | Counselor - Addiction (substance Use Disorder) | 24703 (North Carolina) | Secondary |
1041C0700X | Social Worker - Clinical | C013218 (North Carolina) | Primary |
Group Practice Association
Group Practice Name | Group PECOS PAC ID | No. of Members |
East Carolina University | 0244143246 | 383 |
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. Crystal Dianne Kellam allows following entities to bill medicare on her behalf.
Entity Name | East Carolina University |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1972551919 PECOS PAC ID: 0244143246 Enrollment ID: O20031106000400 |
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Entity Name | Roanoke Valley Health Services Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1720198369 PECOS PAC ID: 4587573159 Enrollment ID: O20050119001033 |
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Entity Name | Vidant Medical Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1477648731 PECOS PAC ID: 0345343893 Enrollment ID: O20070321000445 |
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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. Crystal Dianne Kellam 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 Address | Practice Location Address |
Crystal Dianne Kellam, MSW Po Box 751069, Charlotte, NC 28275-1069 Ph: () - | Crystal Dianne Kellam, MSW 905 Johns Hopkins Dr, Greenville, NC 27834-2056 Ph: (252) 744-1406 |
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