NPIMap

Individual provider Active NPI

Kelly Catherine Wilkinson, M.D.

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1245522036
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-12528 Issued in ID
Practice address
6052 W State St
Boise, ID 83703-2739
Phone
(208) 344-7799
Fax
(207) 344-7152
NPI assigned
May 11, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X M-12528 ID Primary

Addresses

Primary practice location

6052 W State St
Boise, ID 83703-2739

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6522

Other identifiers 1

IdentifierTypeStateIssuer
1245522036MedicaidID

Other names 1

  • Kelly Catherine Albin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150901002007 ID Practitioner - Family PracticePractitioner - Sports Medicine 3274757075 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of California, San Diego School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians
Full Circle Health IncGroup PAC ID 6709986797, 106 clinicians

Practice addresses (Care Compare)

6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947

6565 W Emerald St
Boise, ID 83704-8737
Phone (208) 514-2510

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC Family Medicine CurrentSince Sep 14, 2015 Accepting new patients
Full Circle Health, Inc. CurrentSince Apr 1, 2016 Accepting new patients
Alliance Medical Group, LLC Family Medicine Current Accepting new patients
Alliance Medical Group, LLC Family Medicine Past Accepting new patients

Locations

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

6052 W State St
Boise, ID 83703
Phone (208) 344-7799

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

Interoperability endpoints

  • Direct secure messaging: kelly.wilkinson@phmg.eclinicaldirectplus.com
  • Direct secure messaging: kwilkinson295149@direct.ochin.org

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439424000000",
    "number": "1245522036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6522",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6052 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837032739",
            "telephone_number": "208-344-7799",
            "fax_number": "207-344-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "KELLY",
        "middle_name": "CATHERINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-11",
        "last_updated": "2015-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245522036",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "ALBIN",
            "middle_name": "CATHERINE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.