Shalese Marie Killian, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9012696-4405 Issued in UT

Practice address

250 W 300 N
Roosevelt, UT 84066-2336

Phone

(435) 722-4691

NPI assigned

Mar 10, 2020

Last updated

Mar 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shalese Marie Connary Former name

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Northeastern Utah Medical GroupGroup PAC ID 2961496609, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Canyon Home Care Home health agency, Murray, UT, CCN 467226
• Uintah Basin Medical Center Hospital, Roosevelt, UT, CCN 460019

Merit-based Incentive Payment System (MIPS)

Final score

89.32 of 100Reported as apm

Quality

71.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199
  Medicare reassignment Care Compare group NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment Care Compare group NPD
• Northeastern Utah Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Roosevelt, UT
  • NPI 1740482009
  NPD
• Uintah Basin Medical Center

  dba Uintah Basin Healthcare Vernal Pharmacy

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

• Home Caregivers Partnership, LLC

  dba Canyon Home Care

  • Home Health Agency
  • Murray, UT
  • NPI 1306899265
  Care Compare affiliation
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Care Compare affiliation
• Uintah Basin Medical Center

  dba Uintah Basin Medical Center Vernal

  • General Acute Care Hospital
  • Vernal, UT
  • NPI 1881447571
  Care Compare affiliation
• Uintah Basin Medical Center

  dba UBMC Physical Therapy

  • Physical Therapy Clinic/Center
  • Ballard, UT
  • NPI 1912750662

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584748800000",
    "number": "1346875325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1854",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840661854",
            "telephone_number": "435-724-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLIAN",
        "first_name": "SHALESE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-03-21",
        "certification_date": "2020-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "9012696-4405",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "UT",
            "license": "9012696-3102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHALESE",
            "last_name": "CONNARY",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trinity Jenkins, LCSW
• Patty Jensen
• Preston David Kadleck, LMFT
• Beverly Keel
• Rachelle Linn Killian
• Tammy Killian
• Michiel R. Knight, D.D.S.
• Steven R Knight, CRNA
• Jason Kowallis, OD
• Scott H Kowallis, O.D.

• Family Nurse Practitioner in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2020; 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.