Active NPI
Kelli Renee Roe, P.A.-C
- Surgical Physician Assistant
- Kalamazoo, MI
National Provider Identifier
1225318751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 5601006123
- Practice address
- 1634 Gull Rd
Kalamazoo, MI 49048-1632 - Phone
- (269) 903-2835
- NPI assigned
- Aug 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 5601006123 | MI | Primary |
Addresses
Primary practice location
1634 Gull Rd
Kalamazoo, MI 49048-1632
Mailing address
1634 Gull Rd
Kalamazoo, MI 49048-1632
Phone (269) 903-2835
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225318751 | Medicaid | MI | |
| 1417961137 | Other | MI | BCBSM - BMH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lansing Urgent Care, PLC | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Organizations & group practices 1
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.
-
- Urgent Care Clinic/Center
- Lansing, MI
- NPI 1780987990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456876800000",
"number": "1225318751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1634 GULL RD",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490481632",
"telephone_number": "269-903-2835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1634 GULL RD",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490481632",
"telephone_number": "269-903-2835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROE",
"first_name": "KELLI",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-29",
"last_updated": "2016-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MI",
"license": "5601006123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1225318751",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM - BMH",
"identifier": "1417961137",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.