NPIMap

Individual provider Active NPI

Kelly Lynae Richardson, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1760618730
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7112 Issued in AZ
Practice address
5555 E Baseline Rd
Mesa, AZ 85206-4709
Phone
(480) 393-0575
Fax
(480) 704-4019
NPI assigned
Jun 4, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10561256-1206 UT
Physician Assistant 363A00000X 7112 AZ Primary

Addresses

Primary practice location

5555 E Baseline Rd
Mesa, AZ 85206-4709

Mailing address

5555 E Baseline Rd
Mesa, AZ 85206-4709
Phone (480) 393-0575

Other practice location 1

5121 S Cottonwood St Ste 320
Murray, UT 84107-5701
Phone (801) 507-3380

Other practice location 2

2045 Franklin St
Denver, CO 80205-5437
Phone (303) 203-3797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20191216000964 AZ Practitioner - Physician Assistant 7214299627 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reddy Gi AssociatesGroup PAC ID 1557407459, 18 clinicians

Practice addresses (Care Compare)

1125 S Alma School Rd
Suite 210
Chandler, AZ 85286-2811
Phone (480) 733-7300

37000 N Gantzel Rd
Queen Creek, AZ 85140-7303
Phone (480) 393-0575

9130 E Elliot Rd
Mesa, AZ 85212-9675
Phone (480) 393-0575

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.65 of 100Reported as group
Quality
76.23
Promoting interoperability
100
Improvement activities
40
Cost
75.95

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Specialists Arizona LLC CurrentSince Feb 1, 2026 Accepting new patients
Banner Physician Specialists Arizona LLC CurrentSince Feb 1, 2026 Accepting new patients
Reddy Gi Associates CurrentSince Dec 15, 2024 Accepting new patients
Central Arizona Gi & Liver Institute LLC Past Accepting new patients

Locations

1125 S Alma School Rd
Ste 210
Chandler, AZ 85286
Phone (480) 256-4900

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

5555 E Baseline Rd
Mesa, AZ 85206
Phone (480) 393-5075

9165 W Thunderbird Rd
Ste 200
Peoria, AZ 85381
Phone (623) 285-1120

1441 N 12th St
Fl 3
Phoenix, AZ 85006
Phone (602) 521-5700

1441 N 12th St
Fl 2
Phoenix, AZ 85006
Phone (602) 521-5180

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1760618730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064709",
            "telephone_number": "480-393-0575",
            "fax_number": "480-704-4019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064709",
            "telephone_number": "480-393-0575",
            "fax_number": "480-704-4019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5121 S Cottonwood St Ste 320",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841075701",
            "country_code": "US",
            "telephone_number": "801-507-3380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2045 Franklin St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802055437",
            "country_code": "US",
            "telephone_number": "303-203-3797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KELLY",
        "middle_name": "LYNAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-04",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10561256-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.