Individual provider Active NPI

Kelly Lea Lyons, N.P.

  • Nurse Practitioner
  • Apple Valley, CA
National Provider Identifier
1538413877
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
17303 Issued in CA
Practice address
19059 Bear Valley Rd
Apple Valley, CA 92308-2716
Phone
(760) 515-5000
Fax
(760) 240-3848
NPI assigned
Nov 8, 2012
Last updated
Nov 23, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 17303 CA Primary

Addresses

Primary practice location

19059 Bear Valley Rd
Apple Valley, CA 92308-2716

Mailing address

19059 Bear Valley Rd
Apple Valley, CA 92308-2716
Phone (760) 515-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20130104000421 CA Practitioner - Nurse Practitioner 5991958662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.83
Promoting interoperability
100
Improvement activities
40
Cost
78.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
17303CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Albion Medical Partners of California West P C CurrentSince Feb 1, 2021 Accepting new patients
The Gastro Group, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Diamond Pathology LLC Current Accepting new patients
Caremore Health Plan Nurse Practitioner PastSince Jul 1, 2019 Accepting new patients
Caremore Health Plan Past Accepting new patients

Locations

12900 Park Plaza Dr
Ste 150
Cerritos, CA 90703
Phone (562) 622-2800

12900 Park Plaza Dr
Ste 700
Cerritos, CA 90703
Phone (562) 622-2800

12565 Hesperia Rd
Ste 1
Victorville, CA 92395
Phone (717) 991-5836

12595 Hesperia Rd
Ste 101
Victorville, CA 92395
Phone (760) 881-3377

17203 Jasmine St
Victorville, CA 92395
Phone (760) 881-3377

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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": "1352332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1538413877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19059 BEAR VALLEY RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923082716",
            "telephone_number": "760-515-5000",
            "fax_number": "760-240-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19059 BEAR VALLEY RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923082716",
            "telephone_number": "760-515-5000",
            "fax_number": "760-240-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "KELLY",
        "middle_name": "LEA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-08",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "17303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

Verify at the official NPI Registry.