Kellie A Porter, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP4957 Issued in AZ

Practice address

1876 E Sabin Dr Ste 10
Casa Grande, AZ 85122-6197

Phone

(520) 836-9800

Fax

(520) 836-1510

NPI assigned

May 31, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kporter3907327@ghc.direct-ci.net
• Direct secure messaging: kporter172522@direct.jcl.com

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.

• Adobe Provider Group

  • Nurse Practitioner
  • Tempe, AZ
  • NPI 1659850279
  Medicare reassignment NPD
• Honorhealth Medical Group, LLC

  dba Saguaro Family Practice

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1851336432
  NPD (past)
• Phoenician Hospice LLC

  • Community Based Hospice Care Agency
  • Scottsdale, AZ
  • NPI 1730624461
  NPD (past)

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1619314523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749495",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749495",
            "telephone_number": "866-266-0555",
            "fax_number": "866-266-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1876 E SABIN DR STE 10",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226197",
            "telephone_number": "520-836-9800",
            "fax_number": "520-836-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KELLIE",
        "middle_name": "A",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP4957",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP4957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "209 Martin Luther King Jr Way",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Edward Pinuelas, PT, DPT
• Dietrich W Pitchford
• Megan L Placencia, DPT
• Albert Poma
• Pongratz Orthotics & Prosthetics, Inc
• Daryl B. Potyczka, DDS
• Timothy Scott Powers
• Zachary A Prather, M.D.
• Premier Cardiovascular Center, PLC
• Premise Health of Arizona Medical PC (Price - Casa Grande)

• Nurse Practitioner in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.