Mr Randall Douglas Kelly, MHS, DMSC, PA-C is a medicare enrolled "Physician Assistant" physician in Hermiston, Oregon. He graduated from medical school in 2010 and has 15 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Equinox Clinics Llc and his current practice location is
256 E Hurlburt Ave Ste 117, Hermiston, Oregon. You can reach out to his office (for appointments etc.) via phone at
(541) 303-3558.
Mr Randall Douglas Kelly is licensed to practice in Oregon (license number PA184529) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1922393974.
Physician's Profile
| Full Name | Mr Randall Douglas Kelly |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 15 Years |
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| Location | 256 E Hurlburt Ave Ste 117, Hermiston, Oregon |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mr Randall Douglas Kelly graduated from medical school in 2010
NPI Data:
- NPI Number: 1922393974
- Provider Enumeration Date: 06/16/2011
- Last Update Date: 08/10/2024
Medicare PECOS Information:
- PECOS PAC ID: 0446420004
- Enrollment ID: I20180110000577
Medical Identifiers
Medical identifiers for Mr Randall Douglas Kelly such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1922393974 | NPI | - | NPPES |
| 0281857 | Other | WA | LABOR & INDUSTRIES |
| 2013576 | Medicaid | WA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2083A0300X | Preventive Medicine - Addiction Medicine | PA184529 (Oregon) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | PA60205772 (Washington) | Secondary |
| 363A00000X | Physician Assistant | PA60205772 (Washington) | Secondary |
| 363A00000X | Physician Assistant | PA184529 (Oregon) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Equinox Clinics Llc | 4587992037 | 2 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Randall Douglas Kelly is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Randall Douglas Kelly, MHS, DMSC, PA-C
5426 Road 68 Ste D253,
Pasco, WA 99301-5268
Ph: (541) 303-3558 | Mr Randall Douglas Kelly, MHS, DMSC, PA-C
256 E Hurlburt Ave Ste 117,
Hermiston, OR 97838-2443
Ph: (541) 303-3558 |
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