Kelly Marie Prall, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

677 Kidder Street
Wilkes-Barre TWP., PA 18702

Phone

(570) 825-2046

NPI assigned

Oct 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kelly Marie Pidgeon Other name

Medicare fee-for-service enrollment

Enrolled in PA, NY, NJ, DC4 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 4

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ophelia Medical Group FL PAGroup PAC ID 7810398534, 103 clinicians

Ophelia Medical Group NJ PCGroup PAC ID 0547657397, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Ophelia Medical Group FL, P.a.

  • Addiction Medicine (Family Medicine) Physician
  • Philadelphia, PA
  • NPI 1588244750

  DC, NY

  Medicare reassignment Care Compare group
• Ophelia Medical Group NJ PC

  • Psychiatry Physician
  • Flanders, NJ
  • NPI 1346906179
  Medicare reassignment Care Compare group
• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment
• Geisinger Clinic

  • Family Medicine Physician
  • Selinsgrove, PA
  • NPI 1508292715

  Physician Assistant

  NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• American Sole Emergency Physicians LLC

  • Emergency Medicine Physician
  • Scranton, PA
  • NPI 1427451616

  Physician Assistant

  NPD (past)
• Ophelia Medical Group, P.C.

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Philadelphia, PA
  • NPI 1376179150
  NPD (past)

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1336576305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 KIDDER STREET",
            "city": "WILKES-BARRE TWP.",
            "state": "PA",
            "postal_code": "18702",
            "telephone_number": "570-825-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 KIDDER STREET",
            "city": "WILKES-BARRE TWP.",
            "state": "PA",
            "postal_code": "18702",
            "telephone_number": "570-825-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRALL",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-04",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA003966",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA056199",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PIDGEON",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Discovery House, LLC (Wilkes-Barre Comprehensive Treatment Center)
• Alek Krokos, DC

• Physician Assistant in Wilkes Barre TWP, PA
• Providers in Wilkes Barre TWP, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.