NPIMap

Individual provider Active NPI

Kelly Marie Stevenson, PA-C

  • Physician Assistant
  • Kearney, NE
National Provider Identifier
1154634244
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1535 Issued in NE
Practice address
804 22ND Ave
Kearney, NE 68845-2206
Phone
(308) 455-3600
Fax
(308) 455-3950
NPI assigned
Jul 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1535 NE Primary
Physician Assistant 363A00000X 15-01496 KS

Addresses

Primary practice location

804 22ND Ave
Kearney, NE 68845-2206

Mailing address

804 22ND Ave
Kearney, NE 68845-2206
Phone (308) 455-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20100907000688 NE Practitioner - Physician Assistant 9638293038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brad Rodgers MD Family Practice and Sports Medicine 2 clinicians

Practice addresses (Care Compare)

102 3Rd Ave
Suite a
Kearney, NE 68845-7820
Phone (308) 237-2273

Hospital & facility affiliations

  • Angels Care Progressive Home Health Home health agency, Grand Island, NE, CCN 287144
  • The Nebraska Medical Center Hospital, Omaha, NE, CCN 280013
  • CHI Health Good Samaritan Hospital, Kearney, NE, CCN 280009
  • Kearney Regional Medical Center Hospital, Kearney, NE, CCN 280134

Merit-based Incentive Payment System (MIPS)

Final score
92.6 of 100Reported as apm
Quality
82.13
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.6 of 100Reported as apm
Quality
82.13
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1535NEMDSpeech-Language Pathologist
15-01496KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brodstone Memorial Hospital CurrentSince Jan 10, 2022 Accepting new patients
Brodstone Memorial Hospital Physician Assistant CurrentSince Jan 10, 2022 Accepting new patients
Grand Island Pain Relief Center PC Current Accepting new patients

Locations

403 Lexington Cir
Grand Island, NE 68803
Phone (308) 675-2858

727 E 1st St
Minden, NE 68959
Phone (308) 832-1440

520 E 10th St
Superior, NE 68978
Phone (402) 224-3344

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19476/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418256000000",
    "number": "1154634244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 22ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688452206",
            "telephone_number": "308-455-3600",
            "fax_number": "308-455-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 22ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688452206",
            "telephone_number": "308-455-3600",
            "fax_number": "308-455-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-19",
        "last_updated": "2014-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1535",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01496",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

Verify at the official NPI Registry.