KELLEY A PRINCE (M.D.) – Family Medicine Physician, NPI 1174682124
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
13,194 FAMILY PRACTICE in CA
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Provider Addresses for KELLEY A PRINCE (M.D.)
MemorialCare Medical Foundation, 2742, Dow Avenue, Tustin, Orange County, California, 92780, United States
TUSTIN, CA 927807242
Phone: (714) 665-1600
Type: Mailing
East Yale Loop, Woodbridge, Irvine, Orange County, California, 92614, United States
SUITE 200
IRVINE, CA 926044697
Phone: (949) 551-1090
Fax: (949) 262-5500
Type: Location
PO BOX 280
NORWOOD, CO 814230280
Phone: (970) 327-4233
Fax: (970) 327-4228
Type: Mailing
1350 S ASPEN ST
NORWOOD, CO 81423
Phone: (970) 327-4233
Fax: (970) 327-4228
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-10-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20081118000021 | I | Family Practice | CA | TBD |
| I20221031001407 | I | Family Practice | CO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 22 | 18 | $0 |
Insurance plans in this area (ZIP 92780)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | CO | |
| Nurse Practitioner | AL | |
| Nurse Practitioner | CO | |
| - | CO | |
| - | NM | |
| Clinical Social Worker | KY | |
| Physician Assistant | CO |
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