Kelley Mamede, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

402 S State St
Marion, OH 43302-5000

Phone

(740) 387-0650

NPI assigned

Jan 15, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ohio Emergency Care Services, Inc

  • Emergency Medicine Physician
  • Delaware, OH
  • NPI 1184028524
  Medicare reassignment
• Sudesh S Reddy MD Inc

  • Internal Medicine Physician
  • Marion, OH
  • NPI 1578540910
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1003456286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 BUR REED RD",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430153676",
            "telephone_number": "330-620-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S STATE ST",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433025000",
            "telephone_number": "740-387-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMEDE",
        "first_name": "KELLEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard Macfadden, CRNA
• Mellie J Mack, LPN
• Dalsukh A Madia, M.D.
• Ila D. Madia, M.D.
• Antoinette Mamary, CPST
• Sarah Alyssa Manko, DDS
• Christina Manns, CDCA
• Margaret Mansur, R.D.H.
• Marca Industries, Inc.
• Jeannine Marcum, R.D., L.D.

• Physician Assistant in Marion, OH
• Providers in Marion, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.