NPIMap

Individual provider Active NPI

Kelsey Wise McCoy, PA

  • Medical Physician Assistant
  • Lebanon, VA
National Provider Identifier
1689043952
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
58 Carroll Street
Lebanon, VA 24266
Phone
(276) 883-8000
NPI assigned
Sep 17, 2015
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

58 Carroll Street
Lebanon, VA 24266

Mailing address

21 Tumbez Hollow Rd
Lebanon, VA 24266-5629
Phone (276) 794-9125

Other practice location 1

71 S Flannagan Ave
Suite A
Lebanon, VA 24266
Phone (276) 883-8042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20151222000052 VA Practitioner - Physician Assistant 7012218837 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain States Health AllianceGroup PAC ID 6002726718, 23 clinicians

Practice addresses (Care Compare)

16431 Wise St
Saint Paul, VA 24283-3537
Phone (276) 762-2300

344 Overlook Dr
Suite 100
Lebanon, VA 24266-3436
Phone (276) 883-8042

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain States Health Alliance CurrentSince Feb 12, 2018 Accepting new patients
Mountain States Health Alliance CurrentSince Feb 12, 2018 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Sep 1, 2017 Accepting new patients

Locations

323 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-2612

71 S Flannagan Ave
Ste A
Lebanon, VA 24266
Phone (276) 258-1985

100 15th St NW
Norton, VA 24273
Phone (276) 439-1000

16431 Wise St
Saint Paul, VA 24283
Phone (276) 762-2300

Organizations & group practices 5

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 9

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": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1689043952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 TUMBEZ HOLLOW RD",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242665629",
            "telephone_number": "276-794-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 CARROLL STREET",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "24266",
            "telephone_number": "276-883-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 S Flannagan Ave",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "VA",
            "postal_code": "24266",
            "country_code": "US",
            "telephone_number": "276-883-8042",
            "fax_number": "276-883-8044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "KELSEY",
        "middle_name": "WISE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, VA

Sources for this page

Verify at the official NPI Registry.