Kelly Blount, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

103450 Issued in NC

Practice address

5603 Duraleigh Rd
Suite 111
Raleigh, NC 27612-2688

Phone

(919) 791-0840

Fax

(919) 791-0911

NPI assigned

Jun 16, 2005

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

Medicare fee-for-service enrollment

Enrolled in NC

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Raleigh Medical Group PAGroup PAC ID 6800874322, 99 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Raleigh Medical Group, PA

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1104962315
  Medicare reassignment Care Compare group
• Southern Dermatology, P.a.

  • Specialist
  • Raleigh, NC
  • NPI 1568415586
  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1972508828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5603 DURALEIGH RD",
            "address_2": "SUITE 111",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276122688",
            "telephone_number": "919-791-0840",
            "fax_number": "919-791-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5603 DURALEIGH RD",
            "address_2": "SUITE 111",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276122688",
            "telephone_number": "919-791-0840",
            "fax_number": "919-791-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOUNT",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blossom & Bloom Wellness Services, PLLC
• Shon Blotzer
• Alicia Blount, NP
• Kayla Nichole Blount, LCMHCA
• Keisha J Blount, MA,LCAS,CCS
• Tonya Blowe
• Blue Balloon NC LLC
• Blue Bridge Therapy Mental Health Counseling, PLLC
• Blue Circle Services Inc
• Blue Cross Home Health, Inc.

• Medical Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.