Active NPI
Kelly M Malena, PA C
- Medical Physician Assistant
- Greenville, SC
National Provider Identifier
1275588634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1085
- Practice address
- 200 Patewood Dr
Suite C300
Greenville, SC 29615-3593 - Phone
- (864) 454-8272
- Fax
- (864) 454-2875
- NPI assigned
- May 24, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1085 | SC | Primary |
| Surgical Physician Assistant | 363AS0400X | 1085 | SC |
Addresses
Primary practice location
200 Patewood Dr
Suite C300
Greenville, SC 29615-3593
Mailing address
One Independence Pointe
Suite 212
Greenville, SC 29615-4566
Phone (864) 797-6044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1085 | Medicaid | SC |
Other names 1
- Kelly M Vavro
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1085 | SC | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenville Health System | Past | Accepting new patients | |
| Greenville Proaxis Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Simpsonville, SC
- NPI 1679992838
-
- Physical Therapist
- Greenville, SC
- NPI 1669457859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1275588634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE INDEPENDENCE POINTE",
"address_2": "SUITE 212",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296154566",
"telephone_number": "864-797-6044",
"fax_number": "864-797-6198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PATEWOOD DR",
"address_2": "SUITE C300",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296153593",
"telephone_number": "864-454-8272",
"fax_number": "864-454-2875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALENA",
"first_name": "KELLY",
"middle_name": "M",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-24",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "1085",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "SC",
"license": "1085",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1085",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "VAVRO",
"middle_name": "M",
"credential": "PA C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.