Kellan Kalbaugh, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

60114 Issued in CA

Practice address

1941 Johnson Ave Ste 101
San Luis Obispo, CA 93401-4154

Phone

(805) 782-8844

Fax

(805) 782-8859

NPI assigned

Jul 9, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

University of Nevada School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

James J Lynch M D LTDGroup PAC ID 9133188626, 81 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carson Valley Health Hospital, Gardnerville, NV, CCN 291306
• Carson Tahoe Regional Medical Center Hospital, Carson City, NV, CCN 290019
• Barton Memorial Hospital Hospital, South Lake Tahoe, CA, CCN 050352

Merit-based Incentive Payment System (MIPS)

Final score

96.42 of 100Reported as group

Quality

93.48

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

90.71 of 100Reported as apm

Quality

81.42

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkalbaugh619904@direct.med.utah.edu
• Direct secure messaging: kellan.kalbaugh.1@22724.direct.athenahealth.com

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.

• James J Lynch MD LTD

  dba Swift Institute

  • Specialist
  • Reno, NV
  • NPI 1285649608

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• James J Lynch M D LTD

  dba Swift Institute

  • Durable Medical Equipment & Medical Supplies
  • Carson City, NV
  • NPI 1669157319
  NPD

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

• Barton Healthcare System

  dba Barton Memorial Hospital

  • General Acute Care Hospital
  • South Lake Tahoe, CA
  • NPI 1003867565
  Care Compare affiliation
• Carson Tahoe Regional Healthcare

  • General Acute Care Hospital
  • Carson City, NV
  • NPI 1255360160
  Care Compare affiliation
• Carson Tahoe Regional Healthcare

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Carson City, NV
  • NPI 1568281988

  Hospital

  Care Compare affiliation
• Washoe Barton Medical Clinic a Nevada Nonprofit Corporation

  dba CVMC Outpatient Behavioral Health Clinic

  • Community/Behavioral Health Agency
  • Gardnerville, NV
  • NPI 1104482918

  Hospital

  Care Compare affiliation
• Washoe Barton Medical Clinic a Nevada Nonprofit Corporation

  dba Carson Valley Health

  • Critical Access Hospital
  • Gardnerville, NV
  • NPI 1396799102
  Care Compare affiliation

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1194343731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE STE 101",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014154",
            "telephone_number": "805-782-8844",
            "fax_number": "805-782-8859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE STE 101",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014154",
            "telephone_number": "805-782-8844",
            "fax_number": "805-782-8859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1941 Johnson Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934014174",
            "country_code": "US",
            "telephone_number": "805-782-8844 x161",
            "fax_number": "805-782-8859",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 S Halcyon Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Arroyo Grande",
            "state": "CA",
            "postal_code": "934203839",
            "country_code": "US",
            "telephone_number": "805-782-8844 x161",
            "fax_number": "805-782-8859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALBAUGH",
        "first_name": "KELLAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-09",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "60114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Judkins
• Tiffany Sue Judt
• Nicole Juliano, LMFT 144422
• Steven M. Kadin, PH.D.
• Sukai Kah
• Lacey Morgan Kalinen, PA-C
• Judith Putnam Kaliski, PH.D.
• Sara E Kalton
• Geoffrey L Kamen, M.D.
• Deborah Zonenschein Kamliot

• Medical Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.