Kelli Lyn Kay, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12298680-1206 Issued in UT

Practice address

10628 Park Rd
Charlotte, NC 28210-8407

Phone

(703) 667-1000

NPI assigned

Sep 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Physicians Integrated Care LLCGroup PAC ID 4284548116, 203 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Moab Regional Hospital Hospital, Moab, UT, CCN 461302

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 and National Provider Directory roles.

• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199
  Medicare reassignment Care Compare group
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

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

• Moab Valley Healthcare, Inc

  • Critical Access Hospital
  • Moab, UT
  • NPI 1770513236
  Care Compare affiliation
• Moab Valley Healthcare, Inc.

  • Methadone Clinic
  • Moab, UT
  • NPI 1285380394

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1831648013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10628 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108407",
            "telephone_number": "703-667-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4095 E Pony Express Pkwy Ste 1",
            "address_purpose": "LOCATION",
            "city": "Eagle Mountain",
            "state": "UT",
            "postal_code": "840055531",
            "country_code": "US",
            "telephone_number": "801-429-8037",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1055 N 500 W Bldg A",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-812-5033",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "972 N 600 E",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "846601306",
            "country_code": "US",
            "telephone_number": "385-265-6060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 W State Road 164",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "UT",
            "postal_code": "846535732",
            "country_code": "US",
            "telephone_number": "801-425-4896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAY",
        "first_name": "KELLI",
        "middle_name": "LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06770",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12298680-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "972 N 600 E",
            "city": "Spanish Fork",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846601306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pushpinder Kaur, DDS
• Suneet Kaur, MD
• Larissa Anne Kavanagh, PA
• Kay Counseling, PLLC
• James David Kay, MD
• Nicola Kay, MSW, LCSW-A
• Kia Xiong Kayasith, NP
• Jimmy Kayastha, DDS
• Kaydium Therapy Services LLC
• Sei Dadanette Kayee

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.