Individual provider Active NPI

Kelly Marie Badura, PA

  • Physician Assistant
  • Memphis, TN
National Provider Identifier
1730226804
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1174 Issued in TN
Practice address
8970 Winchester Rd
Memphis, TN 38125
Phone
(901) 794-5806
Fax
(901) 794-7922
NPI assigned
Jan 30, 2007
Last updated
Sep 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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 1174 TN Primary

Addresses

Primary practice location

8970 Winchester Rd
Memphis, TN 38125

Mailing address

965 Ridge Lake Blvd Ste 315
Memphis, TN 38120-9401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20120127000772 TN Practitioner - Physician Assistant 0244120012 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

1500 W Poplar Ave
Collierville, TN 38017-0601

2013 Exeter Rd
Germantown, TN 38138-3946
Phone (901) 737-4035

36 Capital Way
Suite E
Atoka, TN 38004-7986
Phone (901) 837-6801

8138 Country Village Dr
Cordova, TN 38016-2029
Phone (901) 725-8606

8970 Winchester Rd
Memphis, TN 38125-8231
Phone (901) 794-5806

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.87 of 100Reported as group
Quality
64.75
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1653WIMDClinical Neuropsychologist
1174TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Memorial Medical Group Inc CurrentSince Dec 5, 2011 Accepting new patients
Baptist Memorial Medical Group Inc CurrentSince Dec 5, 2011 Accepting new patients

Locations

36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801

1500 W Poplar Ave
Ste 202
Collierville, TN 38017
Phone (901) 861-5111

8138 Country Village Dr
Cordova, TN 38016
Phone (901) 725-8606

6685 Poplar Ave
Ste 120
Germantown, TN 38138
Phone (901) 685-8245

2100 Exeter Rd
Memphis, TN 38138
Phone (901) 757-1350

6305 Humphreys Blvd
Ste 101
Memphis, TN 38120
Phone (901) 227-8930

8040 Wolf River Blvd
Ste 103
Memphis, TN 38138
Phone (901) 725-8606

8970 Winchester Rd
Memphis, TN 38125
Phone (901) 794-5806

Organizations & group practices 3

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 6

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1730226804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 315",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209401",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8970 WINCHESTER RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38125",
            "telephone_number": "901-794-5806",
            "fax_number": "901-794-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADURA",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.