Keely E Vaughan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2812 Issued in TN

Practice address

117 Kennedy Dr
Martin, TN 38237-3394

Phone

(731) 587-9511

Fax

(877) 309-6416

NPI assigned

Aug 5, 2015

Last updated

May 26, 2021By 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

Other identifiers 5

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Martin Medical Center PCGroup PAC ID 9436127008, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adoration Home Health Martin Home health agency, Martin, TN, CCN 447225
• Tennessee Quality Care - Home Health Home health agency, Parsons, TN, CCN 447402
• Volunteer Community Hospital Hospital, Martin, TN, CCN 440061
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• Baptist Memorial Hospital Union City Hospital, Union City, TN, CCN 440130

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Martin Medical Center, P.C.

  • Multi-Specialty Clinic/Center
  • Martin, TN
  • NPI 1629740758
  Medicare reassignment Care Compare group
• Martin Medical Center, P.C.

  • Rural Health Clinic/Center
  • Martin, TN
  • NPI 1093768988
  NPD

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

• Abilishealth Martin, LLC

  dba Adoration Home Health Martin

  • Home Health Agency
  • Martin, TN
  • NPI 1093295040
  Care Compare affiliation
• Baptist Memorial Hospital- Union City Inc

  • General Acute Care Hospital
  • Union City, TN
  • NPI 1114981768
  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Martin Health

  dba West Tennessee Healthcare Volunteer Hospital

  • General Acute Care Hospital
  • Martin, TN
  • NPI 1275505372
  Care Compare affiliation
• Tennessee Valley Home Care, LLC

  dba Tennessee Quality Care - Home Health Central

  • Home Health Agency
  • Parsons, TN
  • NPI 1396702536
  Care Compare affiliation

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1780060319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 KENNEDY DR",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373309",
            "telephone_number": "731-587-9511",
            "fax_number": "877-309-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 KENNEDY DR",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373394",
            "telephone_number": "731-587-9511",
            "fax_number": "877-309-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "KEELY",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-05",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA2812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2153951",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01577761",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "3815442",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5440149",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q018026",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "martinmedicalctr@353.direct.myezyaccess.com",
            "affiliation": "N",
            "address_1": "117 Kennedy Dr",
            "city": "Martin",
            "state": "TN",
            "country_code": "US",
            "postal_code": "382373309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Medical Physician Assistant in Martin, TN
• Providers in Martin, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.