Kelly Loraine Dauer Pham, MD

Primary specialty

Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X

License

0101273373 Issued in VA

Practice address

8230 Boone Blvd Ste 170
Vienna, VA 22182-2621

Phone

(571) 310-2502

Fax

(571) 413-0290

NPI assigned

Apr 28, 2010

Last updated

Apr 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other names 1

• Kelly Loraine Dauer Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

Georgetown University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.pham@386556814622724.direct.elationemr.com

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.

• Reach Pediatric Rehab

  • Pediatric Rehabilitation Medicine Physician
  • Vienna, VA
  • NPI 1770225674

  DC, Multi-Specialty

  Medicare reassignment NPD Authorized official
• Reach Specialties, PLLC

  • Multi-Specialty Clinic/Center
  • Vienna, VA
  • NPI 1154020428
  NPD (past)

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1417274689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8230 BOONE BLVD STE 170",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822621",
            "telephone_number": "571-310-2502",
            "fax_number": "571-413-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8230 BOONE BLVD STE 170",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822621",
            "telephone_number": "571-310-2502",
            "fax_number": "571-413-0290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Sand Point Way NE",
            "address_2": "Department of Pediatric Rehabilitation Medicine",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981053901",
            "country_code": "US",
            "telephone_number": "206-987-1766",
            "fax_number": "206-987-2651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KELLY",
        "middle_name": "LORAINE DAUER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-28",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0101273373",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "DC",
            "license": "185401",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "WA",
            "license": "FE60464961",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "VA",
            "license": "0101273373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.pham@reachpedsrehab.com",
            "affiliation": "N",
            "endpointDescription": "HIPPAA compliant email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8230 Boone Blvd Ste 170",
            "city": "Vienna",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221822621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DAUER",
            "middle_name": "LORAINE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christa Rose Perry, LCSW
• Susan M Perry, LCSW
• Kathy Pesavento, PT
• Yvoune Kara Petrie, DC
• Pham, Biga & Maloney, PLLC
• Tuan Pham, D.M.D.
• Erin Philips, NP
• Phu T. Le, DDS, PC (Tysons Orthodontic Care)
• Physicians Medical Health Group PC
• Physiotherapy Associates Inc (Select Physical Therapy)

• Pediatric Rehabilitation Medicine Physician in Vienna, VA
• Providers in Vienna, VA by specialty
• Pediatric Rehabilitation Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.