Tammy Boyette Kelly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA54682 Issued in CA

Practice address

7051 Alvarado Rd
La Mesa, CA 91942-8901

Phone

(619) 460-7775

NPI assigned

Jan 13, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Tammy Raye Boyette Former name

Medicare fee-for-service enrollment

Enrolled in VA, WA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eppel Family Medicine LLCGroup PAC ID 3870748122, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Eppel Family Medicine LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Port Orchard, WA
  • NPI 1134472947
  Medicare reassignment Care Compare group
• Cardiovascular Associates LTD

  • Cardiovascular Disease Physician
  • Chesapeake, VA
  • NPI 1114971918
  NPD (past)

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

• Commonspirit Washington Community Care

  • General Acute Care Hospital
  • Silverdale, WA
  • NPI 1518912609
  Care Compare affiliation

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

{
    "created_epoch": "1263340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1215267349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7051 ALVARADO RD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919428901",
            "telephone_number": "619-460-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7051 ALVARADO RD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919428901",
            "telephone_number": "619-460-7775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 E Plaza Blvd",
            "address_purpose": "LOCATION",
            "city": "National City",
            "state": "CA",
            "postal_code": "919503342",
            "country_code": "US",
            "telephone_number": "619-474-8989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TAMMY",
        "middle_name": "BOYETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-13",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110003655",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107316",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-02138",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA54682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/HEALTHNET",
            "identifier": "1215267349",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "Y0J7G",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009498400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMMY",
            "last_name": "BOYETTE",
            "middle_name": "RAYE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Meesun Keel-Hammer, PHARM.D.
• Kathleen Matthews Keenan
• Thomas Allen Keller, PH.D.
• Alexandra Kristine Kellogg, PA-C
• Kevin M. Kelly Jr.
• Thomas B Kelly
• Kassandra Jeannette Kelton
• Stephan John Kempiak, M.D,PH.D
• Komal Kenkare, PMHNP-BC
• Lori Sharon Kenny, APRN, CNM

• Medical Physician Assistant in La Mesa, CA
• Providers in La Mesa, 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 Oct 26, 2018; 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.