Individual provider Active NPI

Kelly R Minihane, PA-C

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1487622205
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0002078 Issued in CO
Practice address
3027 N Circle Dr
Colorado Springs, CO 80909-1179
Phone
(719) 776-3216
Fax
(719) 776-3220
NPI assigned
Mar 8, 2006
Last updated
Feb 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0002078 CO Primary
Physician Assistant 363A00000X 085-003885 IL
Medical Physician Assistant 363AM0700X PA.0002078 CO

Addresses

Primary practice location

3027 N Circle Dr
Colorado Springs, CO 80909-1179

Mailing address

3027 N Circle Dr
Colorado Springs, CO 80909-1179
Phone (719) 776-3216

Other names 1

  • Kelly R McMahan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20180328002548 CO Practitioner - Physician Assistant 2365623386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Oklahoma College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

3010 N Circle Dr
100 Orco Ortho Audubn CMG
Colorado Springs, CO 80909-1174
Phone (719) 776-7846

3245 E US Hwy 50 Unit E
Stmcc Urgent
Canon City, CO 81212-9343
Phone (719) 285-2888

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-003885ILMDPhysician Assistant
PA.0002078COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince Jan 1, 2022 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jan 1, 2022 Accepting new patients
Mendota Community Hospital Past Accepting new patients
Osf Multi-Specialty Group Past Accepting new patients
Epiphany Dermatology of Colorado, LLC Past Accepting new patients

Locations

3027 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 577-2555

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1487622205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 N CIRCLE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091179",
            "telephone_number": "719-776-3216",
            "fax_number": "719-776-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3027 N CIRCLE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091179",
            "telephone_number": "719-776-3216",
            "fax_number": "719-776-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINIHANE",
        "first_name": "KELLY",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0002078",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003885",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0002078",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MCMAHAN",
            "middle_name": "R",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.