Kellie Camacho, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9107864 Issued in FL

Practice address

3275 Ponce de Leon Blvd
Coral Gables, FL 33134-7251

Phone

(305) 461-2000

Fax

(786) 228-4035

NPI assigned

May 19, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Derm Group LLPGroup PAC ID 9335478908, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00136
• FHIR API: https://app.meldrx.com/api/fhir/ez_00135
• Direct secure messaging: kellie.camacho.p1@direct.caremax.nextgenshare.com

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.

• The Derm Group LLP

  • Dermatology Physician
  • Coral Gables, FL
  • NPI 1801448519
  Medicare reassignment Care Compare group
• Delilah Alonso MD PA

  • Dermatology Physician
  • South Miami, FL
  • NPI 1053522904
  Medicare reassignment
• Francisco Flores MD PA

  • Dermatology Physician
  • Miramar, FL
  • NPI 1033302260
  NPD

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

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1366853889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11924 FOREST HILL BLVD STE 10A-411",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146256",
            "telephone_number": "305-403-1181",
            "fax_number": "305-403-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3275 PONCE DE LEON BLVD",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331347251",
            "telephone_number": "305-461-2000",
            "fax_number": "786-228-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "KELLIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-19",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107864",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liani Marie Calvo, LMHC
• Manuela Calvo, M.D.
• Nelly Marie Calvo, PHARM.D.
• Ramon B Calvo
• Camacho Rehabilitation Inc
• Daniel Camargo, RBT
• Adela Carmen Cammarota, M.D.
• Dana Nicole Campa, PA-C
• Gladys Maria Campa, LMHC
• Melinda Joy Campagna, ARNP

• Medical Physician Assistant in Coral Gables, FL
• Providers in Coral Gables, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.