Kelly Renet Dale, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601003127 Issued in MI

Practice address

416 Woodland Dr
Sandusky, MI 48471-1047

Phone

(810) 202-6022

Fax

(810) 682-4026

NPI assigned

Jan 2, 2007

Last updated

Nov 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pro-Health Medical FPGroup PAC ID 0042642407, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Medical Center Hospital, Saginaw, MI, CCN 230070

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as group

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: kelly.dale.1@27934.direct.athenahealth.com

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.

• Pro-Health Medical FP

  • Primary Care Clinic/Center
  • Lake Orion, MI
  • NPI 1740841451
  Medicare reassignment Care Compare group
• Lapeer Medical Associates, PC

  • Physician Assistant
  • Lapeer, MI
  • NPI 1164575809
  NPD (past)
• Pro-Health Medical, P.C.

  • Internal Medicine Physician
  • Rego Park, NY
  • NPI 1104124841
  NPD (past)

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

• Covenant Medical Center, Inc.

  dba Covenant Healthcare

  • General Acute Care Hospital
  • Saginaw, MI
  • NPI 1588656946
  Care Compare affiliation

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1952468530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 GERMANIA RD",
            "city": "MARLETTE",
            "state": "MI",
            "postal_code": "484538965",
            "telephone_number": "810-577-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 WOODLAND DR",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711047",
            "telephone_number": "810-202-6022",
            "fax_number": "810-682-4026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Plymouth Rd",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486387135",
            "country_code": "US",
            "telephone_number": "989-323-3863",
            "fax_number": "989-502-1122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "154 S Main St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Frankenmuth",
            "state": "MI",
            "postal_code": "487341692",
            "country_code": "US",
            "telephone_number": "989-502-1122",
            "fax_number": "989-502-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALE",
        "first_name": "KELLY",
        "middle_name": "RENET",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "5601003127",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corporate Health Solutions (Family Chiropractic of Sandusky)
• Kyrstin Coy
• Jesse Cramblit
• Paul Crenshaw
• Madeleine Crowe
• Nicole Dalrymple
• Leann Daniels, RN
• Christina Davenport
• Roger Dean, PH.D
• Sandra Dean

• Medical Physician Assistant in Sandusky, MI
• Providers in Sandusky, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.