NPIMap

Individual provider Active NPI

Kelly M Rueda, PA-C

  • Physician Assistant
  • Amarillo, TX
National Provider Identifier
1902131592
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06448 Issued in TX
Practice address
1000 Craig Dr
Amarillo, TX 79106-4015
Phone
(806) 331-7905
Fax
(806) 731-1516
NPI assigned
Oct 15, 2009
Last updated
Sep 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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 PA06448 TX Primary

Addresses

Primary practice location

1000 Craig Dr
Amarillo, TX 79106-4015

Mailing address

PO Box 201
Amarillo, TX 79105-0201
Phone (806) 358-9400

Other identifiers 2

IdentifierTypeStateIssuer
P00794740OtherTXMEDICARE RR
8374NJOtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20091027000825 TX Practitioner - Physician Assistant 3072650852 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
FMC LTC Aco LLCGroup PAC ID 3678013729, 22 clinicians
FMC Long-Term Care PAGroup PAC ID 7416380423, 23 clinicians

Practice addresses (Care Compare)

2501 Lakeview Dr
Amarillo, TX 79109-1531
Phone (806) 350-8277

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.69 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
68.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA06448TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
FMC Clinics, P.a. Physician Assistant Past Accepting new patients
Amarillo Medical Group LLC Past Accepting new patients
Family Medicine Centers Lab L P Past Accepting new patients
High Plains Medical Group, LLC Past Accepting new patients

Organizations & group practices 6

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 3

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": "1255564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1902131592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791050201",
            "telephone_number": "806-358-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CRAIG DR",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791064015",
            "telephone_number": "806-331-7905",
            "fax_number": "806-731-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUEDA",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-15",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00794740",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8374NJ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.