Kelly Evelyn Brenner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA062568 Issued in PA

Practice address

23845 Holman Hwy Ste 203
Monterey, CA 93940

Phone

(831) 241-9155

Fax

(831) 241-9156

NPI assigned

Sep 18, 2009

Last updated

Oct 11, 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 3

Addresses

Other identifiers 2

Other names 1

• Kelly Evelyn Reynolds Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, PA2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

86.08 of 100Reported as group

Quality

76.48

Promoting interoperability

100

Improvement activities

40

Cost

77.12

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.

• Doctors on Duty Medical Group, Inc

  • Urgent Care Clinic/Center
  • Salinas, CA
  • NPI 1568465466
  Medicare reassignment
• Pinnacle Health Medical Services

  • Family Medicine Physician
  • Harrisburg, PA
  • NPI 1932143427
  Medicare reassignment
• Pinnacle Health Medical Services

  dba UPMC Gastroenterology Associates of Central PA

  • Gastroenterology Physician
  • Mechanicsburg, PA
  • NPI 1295552073
  NPD
• Pinnacle Health Medical Services

  dba UPMC Children's Specialists-Neurology

  • Neurology with Special Qualifications in Child Neurology Physician
  • Lemoyne, PA
  • NPI 1922669050
  NPD
• Mori Bean and Brooks Inc

  dba Coastal Vein Vascular Institute

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1093782070

  Physician Assistant

  NPD (past)
• Rhode Island Medical Imaging Inc

  • Diagnostic Radiology Physician
  • Providence, RI
  • NPI 1942376033
  NPD (past)

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

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1790019040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23845 HOLMAN HWY STE 203",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939405901",
            "telephone_number": "831-241-9155",
            "fax_number": "831-241-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23845 HOLMAN HWY STE 203",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "93940",
            "telephone_number": "831-241-9155",
            "fax_number": "831-241-9156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3599 University Blvd S",
            "address_2": "Bldg. 300",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322164252",
            "country_code": "US",
            "telephone_number": "904-399-5550",
            "fax_number": "904-346-4334",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Corporate Center Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170111758",
            "country_code": "US",
            "telephone_number": "717-763-1174",
            "fax_number": "717-763-8960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "815 Sir Thomas Ct Ste 200",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171094839",
            "country_code": "US",
            "telephone_number": "717-724-0720",
            "fax_number": "717-724-0730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRENNER",
        "first_name": "KELLY",
        "middle_name": "EVELYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-18",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA3854",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56134",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSACHUSETTS REGISTRATION",
            "identifier": "PA3854",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI LICENSE",
            "identifier": "PA570",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrenner203424@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "100 Corporate Center Dr Ste 100",
            "city": "Camp Hill",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170111758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "REYNOLDS",
            "middle_name": "EVELYN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alicia Bravo
• Siovanna Bravo
• Valerie Roxanne Bray-Arias
• Breakthrough Behavior, LLC (Breakthrough Behavior)
• Carol Brenner
• Marybeth Brenning, MA COMMUNICATIVE DIS
• Pamela Ann Breslin, RN
• Philip Stanley Breuleux, DDS
• Anna Brewer, MHS
• Veronica Lynn Brewington, MSW

• Physician Assistant in Monterey, CA
• Providers in Monterey, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.