NPIMap

Individual provider Active NPI

Kelly Duewer, PA

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1649388935
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
01632 Issued in NC
Practice address
3404 Wake Forest Rd # Rod
Raleigh, NC 27609-7340
Phone
(919) 862-5480
Fax
(919) 862-5483
NPI assigned
Aug 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 011430 NY
Physician Assistant 363A00000X 01632 NC Primary

Addresses

Primary practice location

3404 Wake Forest Rd # Rod
Raleigh, NC 27609-7340

Mailing address

3404 Wake Forest Rd
Raleigh, NC 27609-7340
Phone (919) 862-5480

Other identifiers 1

IdentifierTypeStateIssuer
P00388622OtherNYMEDICARE RAILROAD

Other names 1

  • Kelly Burgess Former name

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
I20120405000268 NC Practitioner - Physician Assistant 7517968928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

3400 Wake Forest Rd
Suite 310
Raleigh, NC 27609-7317
Phone (919) 620-4855

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2100 Erwin Rd
Durham, NC 27705
Phone (919) 648-8111

3404 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 862-5400

Interoperability endpoints

  • Direct secure messaging: kduewer71265@direct.medicine.duke.edu

Organizations & group practices 1

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.

Hospital & facility affiliations 8

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": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1649388935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 WAKE FOREST RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097340",
            "telephone_number": "919-862-5480",
            "fax_number": "919-862-5483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3404 WAKE FOREST RD # ROD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097340",
            "telephone_number": "919-862-5480",
            "fax_number": "919-862-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUEWER",
        "first_name": "KELLY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-27",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "011430",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "01632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00388622",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BURGESS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.