Kellie Christine Hergenrader

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA61479777 Issued in WA

Practice address

915 Sheridan St
Port Townsend, WA 98368-2931

Phone

(360) 385-4848

NPI assigned

Jan 1, 2022

Last updated

Apr 16, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson County Public Hospital District No 2Group PAC ID 4789593708, 151 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323
• Olympic Medical Center Hospital, Port Angeles, WA, CCN 500072

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: khergenrader2994188@wm.providencedirect.org

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.

• Jefferson County Public Hospital District No 2

  dba Jefferson Healthcare

  • Critical Access Hospital
  • Port Townsend, WA
  • NPI 1356492953

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Jefferson County Public Hospital District No 2

  dba Jefferson Healthcare Watership Clinic

  • Rural Health Clinic/Center
  • Port Townsend, WA
  • NPI 1760433049

  Multi-Specialty

  NPD (past)
• Jefferson County Public Hospital District No 2

  dba Jefferson Healthcare Sheridan Clinic

  • Rural Health Clinic/Center
  • Port Townsend, WA
  • NPI 1902850753

  Multi-Specialty

  NPD (past)

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

• Clallam County Public Hospital District 2

  dba Olympic Medical Center

  • General Acute Care Hospital
  • Port Angeles, WA
  • NPI 1306845557
  Care Compare affiliation
• Jefferson County Public Hospital District No 2

  dba Jefferson Healthcare Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Port Townsend, WA
  • NPI 1104950039
  Care Compare affiliation
• Jefferson County Public Hospital District No 2

  dba Jefferson Healthcare

  • Critical Access Hospital
  • Port Townsend, WA
  • NPI 1356492953
  Care Compare affiliation
• Jefferson County Public Hospital District No 2

  dba Sleep Medicine, Jefferson Healthcare

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Silverdale, WA
  • NPI 1467664631

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1640995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1447911540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682931",
            "telephone_number": "360-385-4848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1086 Canal Dr",
            "address_purpose": "LOCATION",
            "city": "Gardnerville",
            "state": "NV",
            "postal_code": "894106117",
            "country_code": "US",
            "telephone_number": "775-781-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "834 Sheridan St",
            "address_purpose": "LOCATION",
            "city": "Port Townsend",
            "state": "WA",
            "postal_code": "983682443",
            "country_code": "US",
            "telephone_number": "360-385-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERGENRADER",
        "first_name": "KELLIE",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-01",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61479777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Anne Heil, BA, AAC
• Elisabeth Heiner, PSYD, LMHC
• Ross Heinzinger
• Kari Case Heistand, M.D.
• Kathryn S Henley, RN, APRN
• Amy Hicks, LPN
• Steven Hillman, MD
• Kevin Thomas Hines, P.A.-C
• Linda Ann Hodson, ARNP
• Lindsey Hoffmann, RN

• Physician Assistant in Port Townsend, WA
• Providers in Port Townsend, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; 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.