Individual provider Active NPI

McKelle S Wilwand, PA-C

  • Physician Assistant
  • Rancho Mirage, CA
National Provider Identifier
1396418497
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
60521 Issued in CA
Practice address
39000 Bob Hope Dr, Harry and Diane Rinker BLG
Rancho Mirage, CA 92270-3221
Phone
(760) 568-2684
Fax
(760) 837-2238
NPI assigned
Jul 26, 2021
Last updated
Apr 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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 60521 CA Primary

Addresses

Primary practice location

39000 Bob Hope Dr, Harry and Diane Rinker BLG
Rancho Mirage, CA 92270-3221

Mailing address

PO Box 1730
Rancho Mirage, CA 92270-1058
Phone (760) 568-2684

Other practice location 1

45280 Seeley Dr Fl 2
LA Quinta, CA 92253-6834
Phone (760) 568-2684

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20220207002129 CA Practitioner - Physician Assistant 4385037761 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desert Orthopedic Center a Medical Group IncGroup PAC ID 2466346739, 49 clinicians

Practice addresses (Care Compare)

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 568-2684

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.54 of 100Reported as group
Quality
77.5
Promoting interoperability
99
Improvement activities
40
Cost
65.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60521CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Orthopedic Center a Medical Group Inc PastSince Nov 24, 2019 Accepting new patients

Organizations & group practices 3

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 1

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": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1396418497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1730",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701058",
            "telephone_number": "760-568-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR, HARRY AND DIANE RINKER BLG",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-568-2684",
            "fax_number": "760-837-2238"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45280 Seeley Dr Fl 2",
            "address_purpose": "LOCATION",
            "city": "LA Quinta",
            "state": "CA",
            "postal_code": "922536834",
            "country_code": "US",
            "telephone_number": "760-568-2684",
            "fax_number": "760-837-2238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILWAND",
        "first_name": "MCKELLE",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2023-04-05",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.