Individual provider Active NPI

Kelly Pickering, PA-C

  • Physician Assistant
  • Glendale, CA
National Provider Identifier
1497219380
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61791 Issued in CA
Practice address
1500 E Chevy Chase Dr Ste 401
Glendale, CA 91206-4191
Phone
(818) 863-4444
NPI assigned
Jan 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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 PA61791 CA Primary

Addresses

Primary practice location

1500 E Chevy Chase Dr Ste 401
Glendale, CA 91206-4191

Mailing address

1500 E Chevy Chase Dr Ste 401
Glendale, CA 91206-4191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190313001949 IL Practitioner - Physician Assistant 4880934660 Reassigns benefits to 1 organization
I20230201001161 CA Practitioner - Physician Assistant 4880934660 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1500 E Chevy Chase Dr
Suite 201
Glendale, CA 91206-4199
Phone (818) 863-4099

1500 E Chevy Chase Dr
Suite 401
Glendale, CA 91206-4191
Phone (818) 863-4446

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 409-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.77 of 100Reported as group
Quality
78.77
Promoting interoperability
92
Improvement activities
40
Cost
48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61791CAMDDentist
PA61791CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Feb 20, 2019 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 16, 2023 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 16, 2023 Accepting new patients

Locations

1500 E Chevy Chase Dr
Ste 201
Glendale, CA 91206
Phone (818) 863-4099

1500 E Chevy Chase Dr
Ste 401
Glendale, CA 91206
Phone (818) 863-4444

1700 E Cesar E Chavez Ave
Ste 3300
Los Angeles, CA 90033
Phone (323) 264-2132

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

9650 Gross Point Rd
Ste 2900
Skokie, IL 60076

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

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.

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": "1548374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1497219380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E CHEVY CHASE DR STE 401",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E CHEVY CHASE DR STE 401",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064191",
            "telephone_number": "818-863-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERING",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-25",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA61791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.