Active NPI
Kelli Jean Perry, PA-C
- Physician Assistant
- Lakewood, CO
National Provider Identifier
1669795571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1846
- Practice address
- 165 S. Union Blvd.
Ste #800
Lakewood, CO 80228 - Phone
- (303) 988-2680
- Fax
- (303) 986-8057
- NPI assigned
- Mar 5, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1846 | CO | Primary |
Addresses
Primary practice location
165 S. Union Blvd.
Ste #800
Lakewood, CO 80228
Mailing address
1707 Cole Blvd.
Ste #100
Golden, CO 80401
Phone (303) 716-8018
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18170340 | Medicaid | CO |
Other names 1
- Kelli Jean Eberhardt
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1846 | CO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New West Physicians Inc | Physician Assistant | Past | Accepting new patients |
Interoperability endpoints
- kelli.perry@110253701726212.direct.elationemr.com
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487203200000",
"number": "1669795571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 COLE BLVD.",
"address_2": "STE #100",
"city": "GOLDEN",
"state": "CO",
"postal_code": "80401",
"telephone_number": "303-716-8018",
"fax_number": "303-763-5495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 S. UNION BLVD.",
"address_2": "STE #800",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "80228",
"telephone_number": "303-988-2680",
"fax_number": "303-986-8057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "KELLI",
"middle_name": "JEAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-05",
"last_updated": "2017-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "1846",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18170340",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLI",
"last_name": "EBERHARDT",
"middle_name": "JEAN",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.