MR. KELLY L. MOORES (PA-C) – Surgical Physician Assistant, NPI 1417937194
Surgical Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
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Provider Addresses for MR. KELLY L. MOORES (PA-C)
3030, Harden Boulevard, Lakeland, Polk County, Florida, 33803, United States
LAKELAND, FL 338037952
Phone: (863) 687-1250
Fax: (863) 687-1258
Type: Location
3030 Harden Blvd
Lakeland, FL 338037952
Phone: (863) 687-1250
Fax: (863) 687-1258
Type: Location
Lakeland Regional Health Medical Center, 1324, Lakeland Hills Boulevard, Lakeland, Polk County, Florida, 33805, United States
ATTN: MANAGED CARE DEPT
LAKELAND, FL 338054543
Phone:
Type: Mailing
2400 KATHLEEN RD
LAKELAND, FL 338103077
Phone: (863) 687-1250
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $108.
Total Amount is formed as General ($108) + Research ($0) + Ownership ($0) = $108.
Last reported payment date: 2024-06-13 • Largest payer in this snapshot: Radius Health, Inc. ($108).
Total Amount
$108
General + Research + Ownership
Payments
1
Total payment records
General Amount
$108
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Radius Health, Inc. | $108 |
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: 2005-09-19
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 |
|---|---|---|---|---|
| I20050919000237 | I | Physician Assistant | FL | 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 |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 1,181 | 79 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 224 | 105 | $0 |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 122 | 28 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 102 | 77 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 73 | 54 | $0 |
Insurance plans in this area (ZIP 33803)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | FL | 73562 | X-ray of knee, 3 views | 18 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| - | TX | |
| - | FL | |
| - | FL | |
| Physical Medicine And Rehabilitation | MD | |
| Nurse Practitioner | FL | |
| - | FL | |
| Thoracic Surgery | OH | |
| Nurse Practitioner | FL | |
| Family Practice | FL |
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