Kimberlee R Ketchersid, PA
Individual provider Active NPI Physician Assistant · Pearisburg, VA
NPI 1831580430 · NPPES record last updated May 10, 2018
Key facts
- NPI
- 1831580430
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0110006038 (VA)
- Practice address
- 159 Hartley Way
Pearisburg, VA 24134-2471 - Phone
- (540) 921-6000
- NPI assigned
- Feb 18, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Emory University School of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- MCV Associated Physicians
Practice addresses (Care Compare)
1200 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-9000
1250 E Marshall St
Richmond, VA 23298-5051
401 N 11TH St
Richmond, VA 23219-1914
Phone (804) 828-8737
Hospital & facility affiliations
- Medical College of Virginia Hospitals
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.95 of 100
- Quality
- 69.91
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 77.42
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180327000117 | VA | Practitioner - Physician Assistant | 8224333471 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003293 | CT | MD | Clinical Social Worker |
| 0110006038 | VA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 003293 | CT | |
| Physician Assistant | 363A00000X | 0110006038 | VA | Yes |
Addresses
Primary practice location
159 Hartley Way
Pearisburg, VA 24134-2471
Mailing address
159 Hartley Way
Pearisburg, VA 24134-2471
Phone (540) 921-6000
Other providers in Pearisburg, VA
- Tolmie Margaret Holcomb
- Tiffany Danielle Holt
- Blake Hopkins
- Hunt Enterprises Inc
- Hannah Danielle Keating
- Bradley Mart Lane
- Laura Goodrich Anesthesia Services Inc
- Angela Renae Lilly
- Ravi Kiran Lingineni
- Lupo'S Medical Transportation Company
All providers in Pearisburg, VA · Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.