NPIMap

Individual provider Active NPI

Angela Kellermeyer, PA

  • Physician Assistant
  • Hickory, NC
National Provider Identifier
1598088635
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-02232 Issued in NC
Practice address
116 3Rd St NW Ste 102
Hickory, NC 28601-6137
Phone
(828) 855-1192
Fax
(828) 358-0832
NPI assigned
Mar 3, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 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 0010-02232 NC Primary

Addresses

Primary practice location

116 3Rd St NW Ste 102
Hickory, NC 28601-6137

Mailing address

PO Box 2268
Hickory, NC 28603-2268

Other identifiers 1

IdentifierTypeStateIssuer
790246AMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100329000578 NC Practitioner - Physician Assistant 6305972449 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Toledo College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bowen Primary and Urgent Care PAGroup PAC ID 6103909098, 12 clinicians

Practice addresses (Care Compare)

116 3Rd St NW
Suite 102
Hickory, NC 28601-6137
Phone (828) 855-1192

Hospital & facility affiliations

  • Gentiva Health Services/Salisb Home health agency, Kannapolis, NC, CCN 347170
  • Bayada Home Health Care, Inc Home health agency, Charlotte, NC, CCN 347087
  • Centerwell Home Health Home health agency, Charlotte, NC, CCN 347091
  • Well Care Home Health of Piedmont, Inc. Home health agency, Huntersville, NC, CCN 347258
  • Tillery Compassionate Care Hospice, Albemarle, NC, CCN 341542
  • Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Mar 4, 2019 Accepting new patients
Columbus Regional Health Network CurrentSince Mar 4, 2019 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 4, 2019 Accepting new patients
Scotland Regional Health Network CurrentSince Mar 4, 2019 Accepting new patients
Columbus Regional Health Network CurrentSince Mar 4, 2019 Accepting new patients
Springs Road Consulting LLC PastSince Dec 28, 2022 Accepting new patients
Columbus Regional Health Network Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

920 Church St N
Ste 255
Concord, NC 28025
Phone (704) 403-1331

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

Organizations & group practices 10

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 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": "1267574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1598088635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2268",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286032268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 3RD ST NW STE 102",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286016137",
            "telephone_number": "828-855-1192",
            "fax_number": "828-358-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERMEYER",
        "first_name": "ANGELA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-03",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790246A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.