NPIMap

Individual provider Active NPI

Kimberly Ely, PA-C

  • Physician Assistant
  • Lynwood, CA
National Provider Identifier
1811327810
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA23004 Issued in CA
Practice address
3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone
(310) 900-8900
NPI assigned
Nov 13, 2013
Last updated
Mar 25, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA23004 CA Primary

Addresses

Primary practice location

3630 E Imperial Hwy
Lynwood, CA 90262-2609

Mailing address

3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (310) 900-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190718002727 MD Practitioner - Physician Assistant 0345464525 Reassigns benefits to 4 organizations
I20211214000136 DC Practitioner - Physician Assistant 0345464525 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2000 Medical Pkwy
Suite 101
Annapolis, MD 21401-3743
Phone (410) 268-8862

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

4175 N Hanson Court
201 Luminis Health Breast Center of Bowie
Bowie, MD 20716-3181
Phone (443) 481-5300

4175 N Hanson CT
Bowie, MD 20716-3181

4175 N Hanson CT
Suite 301
Bowie, MD 20716-3186
Phone (410) 268-8862

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.45 of 100Reported as group
Quality
67.28
Promoting interoperability
98
Improvement activities
40
Cost
72.57

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23004CAMDClinical Psychologist
PA23004CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince May 26, 2019 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jun 1, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jun 1, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jun 1, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jan 9, 2022 Accepting new patients
Johns Hopkins University CurrentSince May 26, 2019 Accepting new patients
Luminis Health Medical Group, LLC Past Accepting new patients

Locations

2000 Medical Pkwy
Ste 101
Annapolis, MD 21401
Phone (410) 295-8900

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

201 Defense Hwy
Ste 150
Annapolis, MD 21401

4175 N Hanson Ct
Ste 201
Bowie, MD 20716
Phone (443) 481-1199

1630 Main St
Ste 101
Chester, MD 21619
Phone (410) 604-6560

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

5755 Cedar Ln
Columbia, MD 21044
Phone (410) 381-7171

Interoperability endpoints

  • Direct secure messaging: kely133183@direct.aahs.org

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1811327810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 E IMPERIAL HWY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622609",
            "telephone_number": "310-900-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 E IMPERIAL HWY",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622609",
            "telephone_number": "310-900-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELY",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-13",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA23004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

Verify at the official NPI Registry.