NPIMap

Individual provider Active NPI

Kelli K Desanctis, DO

  • Family Medicine Physician
  • Erie, PA
National Provider Identifier
1598057424
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS016944 Issued in PA
Practice address
2501 W 12TH St
Erie, PA 16505-4527
Phone
(814) 461-6626
Fax
(814) 871-6351
NPI assigned
May 11, 2011
Last updated
Oct 5, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS016944 PA Primary

Addresses

Primary practice location

2501 W 12TH St
Erie, PA 16505-4527

Mailing address

2501 W 12TH St
Erie, PA 16505-4527
Phone (814) 461-6626

Other names 1

  • Kelli K Wienecke Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwienecke150994@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140811000667 PA Practitioner - Family Practice 5799902086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

155 E State St
Albion Family Practice
Albion, PA 16401-1347
Phone (814) 756-4917

2501 W 12TH St
Erie, PA 16505-4527

2501 W 12TH St C
Ahn SV Occupational Medicine
Erie, PA 16505-4527
Phone (814) 452-7879

5930 Old French Rd
Erie, PA 16509-3656
Phone (814) 860-7816

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS016944PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Medical Education and Research Institute Inc Family Medicine CurrentSince Aug 1, 2014 Accepting new patients
Millcreek Family Practice and Internal Medicine Family Medicine Past Accepting new patients

Locations

155 E State St
Albion, PA 16401
Phone (814) 756-4917

145 W 23rd St
Ste 101
Erie, PA 16502
Phone (814) 452-2767

1910 Sassafras St
Ste 100
Erie, PA 16502
Phone (814) 452-5772

2501 W 12th St
Erie, PA 16505
Phone (814) 461-6626

2501 W 12th St
Ste C4
Erie, PA 16505
Phone (814) 461-6626

Interoperability endpoints

  • Direct secure messaging: kwienecke150994@direct.ahn.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Vincent Medical GroupCorry, PA, CCN 393889 Rural health clinic Corporate Director Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1598057424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-461-6626",
            "fax_number": "814-871-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-461-6626",
            "fax_number": "814-871-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANCTIS",
        "first_name": "KELLI",
        "middle_name": "K",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-11",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS016944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwienecke150994@direct.ahn.org",
            "affiliation": "N",
            "address_1": "2501 W 12th St",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165054527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "WIENECKE",
            "middle_name": "K",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.