Kelley Mulfinger McIlvaine, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111274 Issued in FL

Practice address

4197 Woodlands Pkwy
Palm Harbor, FL 34685-3493

Phone

(727) 786-3810

Fax

(727) 786-3855

NPI assigned

Mar 17, 2016

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 1

Other names 1

• Kelley S Mulfinger Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palm Harbor Dermatology PAGroup PAC ID 4789758558, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: kmcilvaine@directaddress.net
• Direct secure messaging: svauiso@directaddress.net

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.

• Palm Harbor Dermatology PA

  • Dermatology Physician
  • Palm Harbor, FL
  • NPI 1497927016
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696032000000",
    "number": "1619338688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 MEMORIAL HWY STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347516",
            "telephone_number": "813-333-1512",
            "fax_number": "813-333-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4197 WOODLANDS PKWY",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346853493",
            "telephone_number": "727-786-3810",
            "fax_number": "727-786-3855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 S Macdill Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336093489",
            "country_code": "US",
            "telephone_number": "813-609-3810",
            "fax_number": "813-559-1846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCILVAINE",
        "first_name": "KELLEY",
        "middle_name": "MULFINGER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-17",
        "last_updated": "2023-09-30",
        "certification_date": "2023-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024945100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmcilvaine@dmp.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4197 Woodlands Pkwy",
            "city": "Palm Harbor",
            "state": "FL",
            "country_code": "US",
            "postal_code": "346853493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "MULFINGER",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bryan F McGoldrick, D.V.M.
• Taylor McGoldrick
• Brandie McGowan
• Lilia McGraw, PH.D., NCSP
• Savannah McGregor
• Robin Wagner McInnis
• Eliana McIntire
• Jakeira McKenzie
• McLaughlin & Marte,M.D.'S, L.L.P.
• Timothy Thomas McLaughlin, M.D.

• Physician Assistant in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2023; 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.