NPIMap

Individual provider Active NPI

Kelly Ashley Boardman, PA-C

  • Medical Physician Assistant
  • Leesburg, VA
National Provider Identifier
1821492067
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110004747 Issued in VA
Practice address
19415 Deerfield Ave
Suite 213
Leesburg, VA 20176-8452
Phone
(703) 729-9220
Fax
(703) 858-3529
NPI assigned
Oct 17, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110004747 VA Primary

Addresses

Primary practice location

19415 Deerfield Ave
Suite 213
Leesburg, VA 20176-8452

Mailing address

2623 Puritan CT
Herndon, VA 20171-2439
Phone (404) 326-2826

Other identifiers 2

IdentifierTypeStateIssuer
1821492067MedicaidVA
30016805880001MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20150127002073 VA Practitioner - Physician Assistant 8325362122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians

Practice addresses (Care Compare)

19415 Deerfield Ave
Suite 112
Leesburg, VA 20176-8470
Phone (703) 724-1195

20955 Professional PLZ
Suite 200
Ashburn, VA 20147-3405
Phone (703) 729-7652

Hospital & facility affiliations

  • Inova Loudoun Hospital Hospital, Leesburg, VA, CCN 490043

Merit-based Incentive Payment System (MIPS)

Final score
92.65 of 100Reported as apm
Quality
85.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110004747VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Loudoun Medical Group, PC CurrentSince Nov 5, 2014 Accepting new patients
Loudoun Medical Group, PC CurrentSince Nov 5, 2014 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

20955 Professional Plz
Ste 200
Ashburn, VA 20147
Phone (703) 729-7652

224D Cornwall St NW
Ste 403
Leesburg, VA 20176
Phone (703) 737-6001

19415 Deerfield Ave
Ste 213
Leesburg, VA 20176
Phone (703) 724-9474

Interoperability endpoints

  • Direct secure messaging: kelly.boardman@lmg1.eclinicaldirectplus.com

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 and National Provider Directory roles.

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": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1821492067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 PURITAN CT",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201712439",
            "telephone_number": "404-326-2826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19415 DEERFIELD AVE",
            "address_2": "SUITE 213",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201768452",
            "telephone_number": "703-729-9220",
            "fax_number": "703-858-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOARDMAN",
        "first_name": "KELLY",
        "middle_name": "ASHLEY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-17",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110004747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821492067",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30016805880001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.