Kelli Twedell, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA11922 Issued in TX

Practice address

5744 LBJ Fwy Ste 100
Dallas, TX 75240-6322

Phone

(214) 466-2828

Fax

(214) 382-9798

NPI assigned

Apr 2, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kelli Kaufman Former name

Medicare fee-for-service enrollment

Enrolled in TX

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Provider Health PAGroup PAC ID 2264531276, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Premier Provider Health PA

  • Infectious Disease Physician
  • Austin, TX
  • NPI 1013397066

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Dallas Center for Sleep Disorders, P.a.

  • Sleep Disorder Diagnostic Clinic/Center
  • Plano, TX
  • NPI 1194744276

  Single Specialty

  NPD (past)
• Han Pham Hulen MD PA

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1407304066
  NPD (past)
• Michael Sutker, M.D., P.a.

  • Surgery Physician
  • Dallas, TX
  • NPI 1861804973

  Single Specialty

  NPD (past)
• Premier Provider Health PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1235280496

  Single Specialty

  NPD (past)
• Premier Provider Health PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1700032745

  Single Specialty

  NPD (past)
• Renovo Wound and Hyperbarics PLLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lewisville, TX
  • NPI 1629683602

  Single Specialty

  NPD (past)
• Premier Provider Health Utah PLLC

  • Internal Medicine Physician
  • Ogden, UT
  • NPI 1699311209

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1477059228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3409",
            "city": "PFLUGERVILLE",
            "state": "TX",
            "postal_code": "786913409",
            "telephone_number": "513-252-7792",
            "fax_number": "513-904-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5744 LBJ FWY STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752406322",
            "telephone_number": "214-466-2828",
            "fax_number": "214-382-9798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7300 Eldorado Pkwy Ste 260",
            "address_purpose": "LOCATION",
            "city": "McKinney",
            "state": "TX",
            "postal_code": "750703826",
            "country_code": "US",
            "telephone_number": "972-747-0440",
            "fax_number": "972-747-0441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TWEDELL",
        "first_name": "KELLI",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA11922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382709902",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "PA11922",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "KAUFMAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristin Kyre Tuttle, OTR
• Rhodeza Tuzon, PT
• Elliot Tverye, M.D.
• Timothy Jon Twaddell, MD
• Daniel Alden Twardowski
• Candace Tweed
• Rachel Tweed
• Twelfth House Counseling
• Diane M Twickler, MD
• Twilight Home Healthcare TX LLC

• Surgical Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Surgical Physician Assistant in Texas

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