Active NPI
Kelli L Scott, PA
- Medical Physician Assistant
- Fountain, CO
National Provider Identifier
1104896448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3224
- Practice address
- 350 Lyckman PL
Fountain, CO 80817-2861 - Phone
- (719) 632-5700
- NPI assigned
- Jan 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 01042 | KS | |
| Medical Physician Assistant | 363AM0700X | 3224 | CO | Primary |
Addresses
Primary practice location
350 Lyckman PL
Fountain, CO 80817-2861
Mailing address
3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917-5147
Phone (719) 632-5700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 426914 | Other | KS | BLUE CROSS/BLUE SHIELD |
| 461466 | Other | KS | CHILDRENS MERCY FAMILY HP |
| 89773373 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3224 | CO | MD | Medical Physician Assistant |
| 01042 | KS | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446768000000",
"number": "1104896448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3205 N ACADEMY BLVD",
"address_2": "SUITE 130",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809175147",
"telephone_number": "719-632-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 LYCKMAN PL",
"city": "FOUNTAIN",
"state": "CO",
"postal_code": "808172861",
"telephone_number": "719-632-5700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCOTT",
"first_name": "KELLI",
"middle_name": "L",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-26",
"last_updated": "2015-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KS",
"license": "01042",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "3224",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "426914",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDRENS MERCY FAMILY HP",
"identifier": "461466",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89773373",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fountain, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.