Kelly Blake Cantu, PA-C

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

1770252017 Issued in SC

Practice address

2000 Center Point Rd Ste 2360
Columbia, SC 29210-5826

Phone

(803) 233-5500

Fax

(803) 258-6395

NPI assigned

Sep 7, 2007

Last updated

Oct 22, 2024By 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 names 1

• Kelly Blake Ryder Former name

Medicare fee-for-service enrollment

Enrolled in SC

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Health of Columbia LLCGroup PAC ID 3577973064, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Active Life Health of Columbia, LLC

  dba Arthritis Knee Pain Centers

  • Physical Medicine & Rehabilitation Physician
  • Columbia, SC
  • NPI 1104425529
  Medicare reassignment Care Compare group
• Active Life Health of Columbia, LLC

  dba Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1851990121
  NPD
• Hartford Physician Services PC

  dba Hartford Medical Group

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1164404117

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1174718738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 CENTER POINT RD STE 2360",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292105826",
            "telephone_number": "803-233-5500",
            "fax_number": "803-258-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CENTER POINT RD STE 2360",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292105826",
            "telephone_number": "803-233-5500",
            "fax_number": "803-258-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTU",
        "first_name": "KELLY",
        "middle_name": "BLAKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "SC",
            "license": "1770252017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "RYDER",
            "middle_name": "BLAKE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wayne M Cannon, O.D.
• Jessica Rowena Cantarutti, CRNA
• Nicole Cantor
• Laurie Anne Cantrell, N.P.
• Matthew G Cantrell, M.D.
• Jewel Leanne Canty, LPC
• Santria L Canzater
• Kathryn Capan, APRN
• Natisha Denise Capers-Howard, APRN
• Hollie Capers, LPC

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.