KELLY L WILSON (PA-C) – Medical Physician Assistant, NPI 1124318027
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
10,570 PHYSICIAN ASSISTANT in CA
Provider Addresses for KELLY L WILSON (PA-C)
5030 J ST
STE 201
SACRAMENTO, CA 958193800
Phone: (916) 455-1155
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 114 Open Payments records for all available years, with a total value of $2,282.
Total Amount is formed as General ($2,282) + Research ($0) + Ownership ($0) = $2,282.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($650).
Total Amount
$2,282
General + Research + Ownership
Payments
114
Total payment records
General Amount
$2,282
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2012-02-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120206000561 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 95004 | Test for allergy using allergenic extract | 872 | 12 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 274 | 137 | $0 |
| 94664 | Evaluation of use of breathing device | 171 | 87 | $0 |
| 94010 | Test to measure expiratory airflow and volume | 138 | 72 | $0 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 56 | 26 | $0 |
Insurance plans in this area (ZIP 95819)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | CA | |
| Physician Assistant | CA | |
| - | CA | |
| Nurse Practitioner | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| Physician Assistant | CA | |
| Nurse Practitioner | CA |
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