Amber Brewer Keller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-03575 Issued in NC

Practice address

4618 Country Club Rd
Winston Salem, NC 27104-3520

Phone

(336) 716-1763

NPI assigned

Aug 10, 2012

Last updated

Dec 4, 2012By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hugh Chatham Memorial Hospital, Inc.Group PAC ID 2062311442, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Hugh Chatham Memorial Hospital, Inc.

  dba Clingman Medical Center

  • Family Medicine Physician
  • Ronda, NC
  • NPI 1447373063
  Medicare reassignment Care Compare group
• Hugh Chatham Memorial Hospital

  dba Hugh Chatham Women's Center

  • Obstetrics & Gynecology Physician
  • Elkin, NC
  • NPI 1215314778
  NPD
• Hugh Chatham Memorial Hospital, Inc

  dba Tri-County Orthopedic & Sports Medicine

  • Orthopaedic Surgery Physician
  • Elkin, NC
  • NPI 1275812273
  NPD

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1164779997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "address_2": "WFU SCHOOL OF MEDICINE DEPARTMENT OF DERMATOLOGY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4618 COUNTRY CLUB RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043520",
            "telephone_number": "336-716-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "AMBER",
        "middle_name": "BREWER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-10",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102742",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita A. Kelkar, M.D/M.P.H.
• Leslie Kellam, DNP
• Lori Goco Kellam, MD
• Molly Kellam, FNP-C
• Thomas Clark Kellam
• Calvin Woodrow Keller, LAT-ATC
• Jennifer Keller, FNP
• Tiffany Keller, NP
• Amber Smoot Kelley, LPC
• Phillip Antonio Kelley, PA-C

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.