NPIMap

Individual provider Active NPI

Kelly Hacker, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1104090208
Registry record updated Apr 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1373 Issued in OK
Practice address
750 NE 13TH St Ste 200
Oklahoma City, OK 73104-5051
Phone
(405) 627-1435
Fax
(405) 627-1869
NPI assigned
Apr 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1373 OK Primary

Addresses

Primary practice location

750 NE 13TH St Ste 200
Oklahoma City, OK 73104-5051

Mailing address

750 NE 13TH St Ste 200
P.O. Box 53188
Oklahoma City, OK 73104-5051
Phone (405) 627-1435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050202000541 OK Practitioner - Physician Assistant 3375594823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Cardiovascular Physicians LLCGroup PAC ID 3577730068, 116 clinicians

Practice addresses (Care Compare)

3433 NW 56TH St
Oklahoma City, OK 73112-4430

3433 NW 56TH St
Suite 760
Oklahoma City, OK 73112-4461
Phone (405) 951-4345

Hospital & facility affiliations

  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Integris Health Woodward Hospital Hospital, Woodward, OK, CCN 370002

Merit-based Incentive Payment System (MIPS)

Final score
84.7 of 100Reported as group
Quality
73.46
Promoting interoperability
100
Improvement activities
40
Cost
69.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Traditions Hospice of Tulsa, LLC Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Janita M. Ardis, M.D. Inc. PastSince May 1, 2020 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: khacker9668@direct.integrisok.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1104090208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 NE 13TH ST STE 200",
            "address_2": "P.O. BOX 53188",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045051",
            "telephone_number": "405-627-1435",
            "fax_number": "405-627-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 NE 13TH ST STE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045051",
            "telephone_number": "405-627-1435",
            "fax_number": "405-627-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.