Kimberly Edmonds, PA-C
Individual provider Active NPI Physician Assistant · Stayton, OR
NPI 1760104855 · NPPES record last updated Jan 26, 2024
Key facts
- NPI
- 1760104855
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA218013 (OR)
- Practice address
- 1401 N 10TH Ave Ste 100
Stayton, OR 97383-1486 - Phone
- (503) 769-6386
- Fax
- (503) 769-5647
- NPI assigned
- Sep 14, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Santiam Memorial Hospital
Practice addresses (Care Compare)
1401 N 10TH Ave
Suite 100
Stayton, OR 97383-1486
Phone (503) 769-6386
Hospital & facility affiliations
- First Call Home Health Agency, LLC
- Santiam Hospital & Clinics
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240212000373 | OR | Practitioner - Physician Assistant | 5496198087 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Santiam Memorial Hospital | Current |
Accepting new patients | |
| Santiam Memorial Hospital | Current |
Accepting new patients |
Locations
1375 N 10th Ave
Ste B
Stayton, OR 97383
Phone (503) 769-7546
1401 N 10th Ave
Ste 100
Stayton, OR 97383
Phone (503) 769-6386
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA218013 | OR | Yes |
Addresses
Primary practice location
1401 N 10TH Ave Ste 100
Stayton, OR 97383-1486
Mailing address
4777 Whitman Cir NE
Salem, OR 97305-3600
Phone (530) 680-1003
Other providers in Stayton, OR
- Ashley Diaz
- Luanna Lee Dishon
- Samantha Divan
- Rochelle Ann Doan
- Mabel Y Dzata
- Emeritus Corporation
- Madison Taylor Eymann
- Sydney Fair
- Fay E. Seppala MD, PC
- Maria A Fife
All providers in Stayton, OR · Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.