NPIMap

Individual provider Active NPI

Kellie Lea Mumford, PA-C

  • Physician Assistant
  • Gaylord, MI
National Provider Identifier
1346496759
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005363 Issued in MI
Practice address
2147 Professional Dr
Gaylord, MI 49735-0003
Phone
(989) 732-1753
Fax
(989) 731-1425
NPI assigned
Aug 18, 2008
Last updated
Dec 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005363 MI Primary

Addresses

Primary practice location

2147 Professional Dr
Gaylord, MI 49735-0003

Mailing address

829 N Center Ave
Suite 298
Gaylord, MI 49735-1595
Phone (989) 731-7708

Other identifiers 1

IdentifierTypeStateIssuer
OF96004OtherMEDICARE GROUP NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kellie.mumford@omhmedicalgroup.directbygreenway.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20081008000486 MI Practitioner - Physician Assistant 9234207952 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great Lakes Orthopaedic Center PCGroup PAC ID 1759371826, 36 clinicians
Northsport Physical Therapy and Rehabilitation P CGroup PAC ID 5294902508, shared by 2 NPIs, 43 clinicians

Practice addresses (Care Compare)

1050 S Otsego Ave
Gaylord, MI 49735-9171
Phone (231) 935-0900

1400 Mercy Dr
Suite 100
Muskegon, MI 49444-1833
Phone (231) 733-1326

1622 Dickerson Rd
Gaylord, MI 49735-9206

4045 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-0900

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Muskegon, PC CurrentSince Apr 1, 2026 Accepting new patients
Orthopaedic Associates of Muskegon, PC CurrentSince Apr 1, 2026 Accepting new patients
Petoskey Surgeons, P.C. Past Accepting new patients

Locations

1400 Mercy Dr
Ste 100
Muskegon, MI 49444
Phone (231) 733-1326

Interoperability endpoints

  • Direct secure messaging: kellie.mumford.1@27291.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1346496759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "address_2": "SUITE 298",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 PROFESSIONAL DR",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497350003",
            "telephone_number": "989-732-1753",
            "fax_number": "989-731-1425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUMFORD",
        "first_name": "KELLIE",
        "middle_name": "LEA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "OF96004",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellie.mumford@omhmedicalgroup.directbygreenway.com",
            "affiliation": "N",
            "address_1": "2147 Professional Dr",
            "city": "Gaylord",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497350003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.