Kelly J Walworth, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1460 Issued in OK

Practice address

13174 N Macarthur Blvd
Oklahoma City, OK 73142-3017

Phone

(405) 721-5555

Fax

(405) 470-7093

NPI assigned

Nov 21, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mark a Dawkins, MD, PCGroup PAC ID 6800823667, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

79.69 of 100Reported as group

Quality

65.67

Improvement activities

40

Cost

78.08

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Mark a Dawkins MD PC

  • Specialist
  • Oklahoma City, OK
  • NPI 1710198569
  Medicare reassignment Care Compare group
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1376526756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 96-0317",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731960317",
            "telephone_number": "405-521-1969",
            "fax_number": "405-521-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13174 N MACARTHUR BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731423017",
            "telephone_number": "405-721-5555",
            "fax_number": "405-470-7093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALWORTH",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1710198569",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200265130A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Elizabeth Walton, BCBA
• Michelle Walton, RN, IBCLC
• Michelle Jarvis Walton, D.C.
• Sydney A Walton
• John Michael Waltz, MSW
• John Wambugu
• Alexander Wand
• Chantal Z Wandick, BHR
• Jessica Wang, PHARMD
• Kevin Wang

• Medical Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.