NPIMap

Individual provider Active NPI

Kelle A Rissmiller, PA-C

  • Physician Assistant
  • Parker, CO
National Provider Identifier
1639751506
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006734 Issued in CO
Practice address
19964 Hilltop Rd Ste a
Parker, CO 80134-7316
Phone
(303) 841-2212
NPI assigned
Apr 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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 PA.0006734 CO Primary

Addresses

Primary practice location

19964 Hilltop Rd Ste a
Parker, CO 80134-7316

Mailing address

2255 S Oneida St
Denver, CO 80224-2522
Phone (303) 360-6276

Other practice location 1

2255 S Oneida St
Denver, CO 80224-2522
Phone (303) 360-6276

Other names 1

  • Kelle Lysinger Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20211025002812 CO Practitioner - Physician Assistant 8123416161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1100 E Prospect Rd
BLDG a
Fort Collins, CO 80525-5304
Phone (970) 297-6630

1106 E Prospect Rd
Building B Suite 100
Fort Collins, CO 80525-5304
Phone (970) 495-7410

19964 Hilltop Rd
Suite a
Parker, CO 80134-7316
Phone (303) 841-2212

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Nov 15, 2021 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

19964 Hilltop Rd
Ste A
Parker, CO 80134
Phone (303) 841-2212

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 and National Provider Directory roles.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1639751506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 S ONEIDA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802242522",
            "telephone_number": "303-360-6276",
            "fax_number": "303-789-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19964 HILLTOP RD STE A",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347316",
            "telephone_number": "303-841-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2255 S Oneida St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802242522",
            "country_code": "US",
            "telephone_number": "303-360-6276",
            "fax_number": "303-789-7222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RISSMILLER",
        "first_name": "KELLE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLE",
            "last_name": "LYSINGER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Parker, CO

Sources for this page

Verify at the official NPI Registry.