Kiersten Rene Carrico, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1001557A Issued in IN

Practice address

7950 W Jefferson Blvd
Sutie 2121
Fort Wayne, IN 46804-4140

Phone

(260) 435-7937

Fax

(260) 435-7933

NPI assigned

May 30, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kiersten Rene Yake Former name

Medicare fee-for-service enrollment

Enrolled in IN, FL2 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

Merit-based Incentive Payment System (MIPS)

Final score

95.38 of 100Reported as group

Quality

87.23

Promoting interoperability

100

Improvement activities

40

Cost

83.74

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.

• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment NPD
• Clarksville Emergency Group, PC

  • Emergency Medicine Physician
  • Corydon, IN
  • NPI 1023487154
  Medicare reassignment
• Professional Emergency Physicians PC

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1144215096
  Medicare reassignment
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1508203597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10351 DAWSONS CREEK BLVD",
            "address_2": "SUITE A-1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251904",
            "telephone_number": "260-203-9600",
            "fax_number": "260-739-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "address_2": "SUTIE 2121",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-435-7937",
            "fax_number": "260-435-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRICO",
        "first_name": "KIERSTEN",
        "middle_name": "RENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-30",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "1001557A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIERSTEN",
            "last_name": "YAKE",
            "middle_name": "RENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trevon Carr
• Christopher Edson Carrel, MD
• Gabrielle Octavia Carreon, PHARMD, MSPGX
• Alexis Carrico, PA
• Julie A Carrico, SLP
• Bella Carrillo
• Betsy Carroll
• Janet Carroll, R.N., M.T.
• Carter Hearing Clinics LLC
• Ashlee Denise Carter, CNM

• Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.