NPIMap

Individual provider Active NPI

Mary Anne Kidwell, PA-C

  • Medical Physician Assistant
  • Delray Beach, FL
National Provider Identifier
1649365289
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9118662 Issued in FL
Practice address
5352 Linton Blvd
Delray Beach, FL 33484-6514
Phone
(561) 498-4440
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA839 NV
Physician Assistant 363A00000X 1537 SD
Medical Physician Assistant 363AM0700X PA839 NV
Medical Physician Assistant 363AM0700X 9118662 FL Primary

Addresses

Primary practice location

5352 Linton Blvd
Delray Beach, FL 33484-6514

Mailing address

5190 Las Verdes Cir Apt 212
Delray Beach, FL 33484-8048
Phone (702) 332-4191

Other identifiers 4

IdentifierTypeStateIssuer
PA839OtherNVSTATE LICENSE
9118662OtherFLSTATE LICENSE
1537OtherSDSTATE LICENSE
1649365289MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, SD, FL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040722000824 NV Practitioner - Physician Assistant 9234119074 Reassigns benefits to 3 organizations
I20241016004119 SD Practitioner - Physician Assistant 9234119074 Reassigns benefits to 2 organizations
I20250106003797 FL Practitioner - Physician Assistant 9234119074 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.27 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.53 of 100Reported as group
Quality
80.98
Promoting interoperability
100
Improvement activities
40
Cost
70.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1537SDMDCardiovascular Disease Physician
9118662FLMDMedical Physician Assistant
PA839NVMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network CurrentSince Aug 20, 2024 Accepting new patients
Avera Gettysburg Physician Assistant CurrentSince Aug 16, 2024 Accepting new patients
Sanford Health Network CurrentSince Aug 20, 2024 Accepting new patients
Agata-Venger Partnership Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Intermountain Medical Holdings Nevada Inc Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Sanford Health Network Past Accepting new patients
Linda L. Johnson MD, LTD Past Accepting new patients
Family Doctors Ramanathan, PLLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Gastroenterology Center of Nevada, LLP (Desai) Past Accepting new patients

Locations

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

606 E Garfield Ave
Ste C
Gettysburg, SD 57442
Phone (605) 765-2273

20 S Plum St
Vermillion, SD 57069
Phone (605) 624-2611

Organizations & group practices 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1649365289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5190 LAS VERDES CIR APT 212",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334848048",
            "telephone_number": "702-332-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5352 LINTON BLVD",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334846514",
            "telephone_number": "561-498-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDWELL",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA839",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1537",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA839",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9118662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA839",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9118662",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1537",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649365289",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delray Beach, FL

Sources for this page

Verify at the official NPI Registry.