NPIMap

Individual provider Active NPI

Andrea Maluta Kelly, P.A.

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1689956641
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001004126 Issued in NC
Practice address
2015 Randolph Rd Ste 208
Charlotte, NC 28207-1241
Phone
(704) 377-4009
NPI assigned
Sep 15, 2011
Last updated
Nov 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001004126 NC Primary

Addresses

Primary practice location

2015 Randolph Rd Ste 208
Charlotte, NC 28207-1241

Mailing address

13808 Professional Center Dr Ste 302
Huntersville, NC 28078-7948
Phone (704) 377-4009

Other names 1

  • Andrea Maluta Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Charlotte

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
I20141014000674 NC Practitioner - Physician Assistant 8729208814 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2015 Randolph Rd
Charlotte, NC 28207-1200
Phone (704) 377-4009

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.22 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
84.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001004126NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Digestive Health Associates, PA CurrentSince Aug 20, 2018 Accepting new patients
Charlotte Gastroenterology & Hepatology, PLLC CurrentSince Dec 17, 2019 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Charlotte Gastroenterology & Hepatology, PLLC Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

11301 Carmel Commons Blvd
Ste 302
Charlotte, NC 28226

11430 Red Rust Ln
Ste 201
Charlotte, NC 28277

15830 Ballantyne Medical Pl
Ste 150
Charlotte, NC 28277

2015 Randolph Rd
Ste 101
Charlotte, NC 28207
Phone (704) 602-6544

2015 Randolph Rd
Ste 208
Charlotte, NC 28207
Phone (704) 602-6544

300 Billingsley Rd
Ste 200
Charlotte, NC 28211
Phone (704) 372-3350

705 Griffith St
Ste 205
Davidson, NC 28036
Phone (704) 799-2750

13808 Professional Center Dr
Huntersville, NC 28078
Phone (704) 717-5549

13808 Professional Center Dr
Ste 302
Huntersville, NC 28078

Organizations & group practices 4

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 5

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": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1689956641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13808 PROFESSIONAL CENTER DR STE 302",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787948",
            "telephone_number": "704-377-4009",
            "fax_number": "704-602-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 RANDOLPH RD STE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071241",
            "telephone_number": "704-377-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ANDREA",
        "middle_name": "MALUTA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001004126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Charlotte",
            "affiliation": "N",
            "address_1": "2015 Randolph Rd Ste 208",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "MALUTA",
            "credential": "P.A",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.