Kelly Leah Glick, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0507 Issued in ND

Practice address

2500 Fairway St
Dickinson, ND 58601-2639

Phone

(701) 456-4200

Fax

(701) 456-4545

NPI assigned

Oct 31, 2012

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Omaha Therapy IncGroup PAC ID 1557270915, 68 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Alexius Health Dickinson Hospital, Dickinson, ND, CCN 351336
• CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002

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.

• St Joseph's Hospital and Health Center

  dba CHI St Alexius Health Dickinson

  • Critical Access Hospital
  • Dickinson, ND
  • NPI 1992947956
  Medicare reassignment NPD
• St Joseph's Hospital and Health Center

  dba CHI St Alexius Health Dickinson Medical Clinic

  • Clinic/Center
  • Dickinson, ND
  • NPI 1730464108
  Medicare reassignment NPD (past)
• Omaha Therapy, Inc

  dba Rehab Visions

  • Rehabilitation Clinic/Center
  • Dickinson, ND
  • NPI 1730280371
  Care Compare group
• St Joseph's Hospital and Health Center

  dba CHI St. Alexius Health Beach Family Clinic

  • Rural Health Clinic/Center
  • Beach, ND
  • NPI 1669491262
  NPD
• St Josephs Hospital and Health Center

  dba Badlands ENT

  • Otolaryngology Physician
  • Dickinson, ND
  • NPI 1851311815
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph's Hospital and Health Center

  dba CHI St Alexius Health Dickinson

  • Critical Access Hospital
  • Dickinson, ND
  • NPI 1992947956
  Care Compare affiliation
• St. Alexius Medical Center

  dba CHI St. Alexius Health

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1306832654
  Care Compare affiliation

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1578817466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 FAIRWAY ST",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012639",
            "telephone_number": "701-456-4200",
            "fax_number": "701-456-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 FAIRWAY ST",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012639",
            "telephone_number": "701-456-4200",
            "fax_number": "701-456-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "KELLY",
        "middle_name": "LEAH",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-31",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452926",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71219",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Gietzen, NP
• Miriam Gikiri
• Bruce E Gillette, LAC
• Linda L Gillette, LAC
• Dana Marie Glasser, FNP
• Nancy Goellner, LBSW
• Iran K Gonzalez
• Cory Gooch
• Sheldon R Gordon, D.C.
• Grace & Wisdom Counseling PLLC

• Physician Assistant in Dickinson, ND
• Providers in Dickinson, ND by specialty
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; 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.