Kelli Beaudoin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003485 Issued in MI

Practice address

18100 Oakwood Blvd
Suite 300
Dearborn, MI 48124-4085

Phone

(313) 429-7977

Fax

(313) 429-7981

NPI assigned

Jul 3, 2006

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

Other names 1

• Kelli Crawford Former name

Medicare fee-for-service enrollment

Enrolled in MI

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eric T Silberg MD PCGroup PAC ID 1759319031, 4 clinicians

Practice addresses (Care Compare)

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.

• Eric T Silberg MD PC

  • Orthopaedic Surgery Physician
  • Dearborn, MI
  • NPI 1063516565

  MI

  Medicare reassignment Care Compare group
• Michigan Orthopedic Specialists, PC

  • Orthopaedic Surgery Physician
  • Dearborn, MI
  • NPI 1598110348

  MI

  Medicare reassignment

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1891725495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21031 MICHIGAN AVE",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242339",
            "telephone_number": "313-277-6700",
            "fax_number": "313-216-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18100 OAKWOOD BLVD",
            "address_2": "SUITE 300",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244085",
            "telephone_number": "313-429-7977",
            "fax_number": "313-429-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUDOIN",
        "first_name": "KELLI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003485",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601003485",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "CRAWFORD",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tierra Beason
• Alastair Beatingo
• Erin Lynne Beattie, RDN
• Justine Beaudette, B.S.
• Caitlynn Amanda Beaudoin
• Noah Nicholas Beaudrie
• Ebony Beauford
• Beaumont Medical Group- Specialty Services
• Beaumont Medical Group- Specialty Services
• Beaumont Medical Group- Specialty Services

• All providers in Dearborn, MI
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; 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.