KELLIE BUCCETTI – Acute Care Nurse Practitioner, NPI 1114774155

KELLIE BUCCETTI is a healthcare provider. based in Wallingford, Connecticut. specializing in NURSE PRACTITIONER. They hold a License No. 13699 (CT). The NPI Number for KELLIE BUCCETTI is 1114774155

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
KELLIE BUCCETTI
NPI
1114774155
Phone
(203) 710-3992
Address
5 SUSAN DR
Enumeration Date
6 May 2024
Last Update Date
15 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2032387747
Graduation Year
2024 (2 years ago)
PAC ID
3375070089
Group Practice PAC ID
7416840699
Professional Enrollment ID
I20241219000856
Address ID
CT064512101ME435XXAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience33
Completeness75
Years active:2State licenses:1Digital endpointsOther names

4,196 NURSE PRACTITIONER in CT

Provider Addresses for KELLIE BUCCETTI

  • 5 SUSAN DR

    WALLINGFORD, CT 064921939

    Phone: (203) 710-3992

    Type: Mailing

  • 80 SEYMOUR ST

    HARTFORD, CT 061063315

    Phone: (203) 710-3992

    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: 2024-12-19

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241219000856INurse PractitionerCTTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06492)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7416840699View full group profile
NameSpecialtyState
Cardiovascular Disease (Cardiology)NY
Physician AssistantCT
Internal Medicine, HospitalistTN
Physician AssistantCT
Physician AssistantCT
N E U R O L O G YCT
Physician AssistantCT
Internal MedicineCT
-CT
-CT

Reviews

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Frequently asked questions

Can I cross-check KELLIE BUCCETTI using NPI 1114774155?
NPI 1114774155 belongs to KELLIE BUCCETTI; compare other details if you need extra assurance.
Is KELLIE BUCCETTI shown as active in public data?
Registry records indicate KELLIE BUCCETTI maintains an active NPI.
What clinical focus is listed for KELLIE BUCCETTI?
At a glance, KELLIE BUCCETTI is tied to Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is KELLIE BUCCETTI associated with Wallingford?
Public fields place KELLIE BUCCETTI around Wallingford, Connecticut. Always confirm the exact site before visiting.
Can I trust this NPI listing for KELLIE BUCCETTI?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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