Nicole Keller, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MPA.4324 Issued in SC

Practice address

3440 Declaration Blvd
Sumter, SC 29154-8139

Phone

(803) 905-3278

Fax

(803) 905-3282

NPI assigned

Mar 2, 2022

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 names 1

• Nicole Martin Former name

Medicare fee-for-service enrollment

Enrolled in SC

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brian Lecher PCGroup PAC ID 5294762647, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Tuomey Hospital Hospital, Sumter, SC, CCN 420070

Merit-based Incentive Payment System (MIPS)

Final score

84.79 of 100Reported as individual

Quality

77.09

Improvement activities

40

Cost

79.85

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Brian Lecher, PC

  • Urgent Care Clinic/Center
  • Sumter, SC
  • NPI 1124180732
  Medicare reassignment Care Compare group

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

• Prisma Health-Midlands

  • General Acute Care Hospital
  • Sumter, SC
  • NPI 1326043548
  Care Compare affiliation

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1669129458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 DECLARATION BLVD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291548139",
            "telephone_number": "803-905-3278",
            "fax_number": "803-905-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 DECLARATION BLVD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291548139",
            "telephone_number": "803-905-3278",
            "fax_number": "803-905-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "MPA.4324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "MARTIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Varsha Kapoor, DMD
• Corinne Mary Karch, MD
• Angela Keith
• Mary Katherine Keith
• Mekaiyah Cherron Keith
• Imani Kelley
• Elizabeth Ryan Kellogg, FNP
• William Scott Kellogg, MD
• Amy Kelly, NP
• Kimberly L Kelly, M.AUD.

• Physician Assistant in Sumter, SC
• Providers in Sumter, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.
• 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.