Kimberly Edmonds, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA218013 Issued in 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

Last updated

Jan 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Santiam Memorial HospitalGroup PAC ID 6103729751, 128 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• First Call Home Health Agency, LLC Home health agency, Salem, OR, CCN 387147
• Santiam Hospital & Clinics Hospital, Stayton, OR, CCN 380056

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Medicare reassignment Care Compare group NPD
• Santiam Memorial Hospital

  dba Santiam Health & Wellness Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stayton, OR
  • NPI 1801787171
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• First Call Home Health Agency, LLC

  • Home Health Agency
  • Salem, OR
  • NPI 1740260801
  Care Compare affiliation
• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Care Compare affiliation
• Santiam Memorial Hospital

  • Ambulance
  • Stayton, OR
  • NPI 1962566752

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1760104855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 WHITMAN CIR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973053600",
            "telephone_number": "530-680-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N 10TH AVE STE 100",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973831486",
            "telephone_number": "503-769-6386",
            "fax_number": "503-769-5647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDS",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA218013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Diaz
• Luanna Lee Dishon, MSN, APRN, FNP-C
• Samantha Divan, PHARMD
• Rochelle Ann Doan, RPH
• Mabel Y Dzata, CNM RNP
• Emeritus Corporation (Brookdale Stayton)
• Madison Taylor Eymann, DPT
• Sydney Fair, OT
• Fay E. Seppala MD, PC
• Maria A Fife, FNP

• Physician Assistant in Stayton, OR
• Providers in Stayton, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.