Kylie Ruth Fackrell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

617 E Riverside Dr Ste 301
St George, UT 84790-8722

Phone

(435) 216-7000

NPI assigned

Aug 3, 2019

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 UT, NV2 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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Desert Pain Specialists LLCGroup PAC ID 3072683051, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St. George Regional Hospital Hospital, St George, UT, CCN 460021

Merit-based Incentive Payment System (MIPS)

Final score

77.53 of 100Reported as group

Quality

59.7

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Desert Pain Specialists, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Saint George, UT
  • NPI 1871762450

  NV

  Medicare reassignment Care Compare group

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

• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • St George, UT
  • NPI 1366452880
  Care Compare affiliation

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

{
    "created_epoch": "1564790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1790330108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 E RIVERSIDE DR",
            "address_2": "STE 301",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908722",
            "telephone_number": "435-216-7000",
            "fax_number": "435-216-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E RIVERSIDE DR STE 301",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908722",
            "telephone_number": "435-216-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKRELL",
        "first_name": "KYLIE",
        "middle_name": "RUTH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-03",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gavin James Eyre, RN
• Valerie Faaootoa
• Andrea Fabian Elizalde
• Matthew Fabiszak, DO
• Kalli Ann Fackrell
• Ellen Fagergren
• Marlene Fahnestock
• Aspen Fairbanks
• Ruth Anna Fairbanks
• Kent Christian Fairbourn

• Physician Assistant in St George, UT
• Providers in St George, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; 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.