NPIMap

Individual provider Active NPI

Kelly Haumesser

  • Medical Physician Assistant
  • Saint Marys, PA
National Provider Identifier
1326753336
Registry record updated Oct 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA065742 Issued in PA
Practice address
761 Johnsonburg Rd Ste 160
Saint Marys, PA 15857-3484
Phone
(814) 788-8777
Fax
(814) 788-8770
NPI assigned
Jan 16, 2023
Last updated
Oct 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA065742 PA Primary

Addresses

Primary practice location

761 Johnsonburg Rd Ste 160
Saint Marys, PA 15857-3484

Mailing address

761 Johnsonburg Rd Ste 160
Saint Marys, PA 15857-3484
Phone (814) 594-7458

Other identifiers 2

IdentifierTypeStateIssuer
MA065742OtherPASTATE BOARD OF MEDICINE
OA006939OtherPASTATE BOARD OF OSTEOPATHIC MEDICINE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20241104003523 PA Practitioner - Physician Assistant 9638602295 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians

Practice addresses (Care Compare)

145 Hospital Ave
Suite 315
Du Bois, PA 15801-1465
Phone (814) 503-4305

761 Johnsonburg Rd
Suite 160
Saint Marys, PA 15857-3484
Phone (814) 788-8777

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brookville Hospital CurrentSince Oct 11, 2025 Accepting new patients
Dubois Regional Medical Center CurrentSince Sep 27, 2024 Accepting new patients
Dubois Regional Medical Center CurrentSince Sep 27, 2024 Accepting new patients
Brookville Hospital CurrentSince Oct 11, 2025 Accepting new patients
Brookville Hospital CurrentSince Dec 1, 2025 Accepting new patients
Dubois Regional Medical Center Past Accepting new patients

Locations

100 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1408

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

271 Railroad St
Philipsburg, PA 16866
Phone (814) 342-1872

250 W Main St
Ridgway, PA 15853
Phone (814) 772-8122

761 Johnsonburg Rd
Ste 160
Saint Marys, PA 15857
Phone (814) 788-8777

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728777600000",
    "number": "1326753336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 JOHNSONBURG RD STE 160",
            "city": "SAINT MARYS",
            "state": "PA",
            "postal_code": "158573484",
            "telephone_number": "814-594-7458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 JOHNSONBURG RD STE 160",
            "city": "SAINT MARYS",
            "state": "PA",
            "postal_code": "158573484",
            "telephone_number": "814-788-8777",
            "fax_number": "814-788-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUMESSER",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2024-10-13",
        "certification_date": "2024-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA065742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF MEDICINE",
            "identifier": "MA065742",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF OSTEOPATHIC MEDICINE",
            "identifier": "OA006939",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Marys, PA

Sources for this page

Verify at the official NPI Registry.