KELLY L DUSTIN (DO) – Family Medicine Physician, NPI 1114957362

KELLY L DUSTIN (DO) is a healthcare provider. based in Twin falls, Idaho. specializing in FAMILY PRACTICE. They hold the professional credentials DO. They hold a License No. O-0459 (ID). The NPI Number for KELLY L DUSTIN (DO) is 1114957362

Main info

Male
20 Years Of Experience
Accepts Medicare Assignment
Name
KELLY L DUSTIN (DO)
NPI
1114957362
Phone
(208) 734-3312
Address
794 EASTLAND DR
Enumeration Date
4 July 2006
Last Update Date
19 November 2019

Doctor Profile

Medical School Name
AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Secondary Phone
2088815222
Graduation Year
2006 (20 years ago)
PAC ID
2264583459
Group Practice PAC ID
4981846698
Professional Enrollment ID
I20090629000517
Address ID
ID834404104RE2000XLOOP300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience61
Completeness75
Years active:19State licenses:2Digital endpointsOther names

969 FAMILY PRACTICE in ID

Provider Addresses for KELLY L DUSTIN (DO)

  • Eastland Drive, Twin Falls, Twin Falls County, Idaho, 83301, United States

    TWIN FALLS, ID 833016856

    Phone: (208) 734-3312

    Fax: (208) 734-5036

    Type: Mailing

  • 21 WINN DR

    REXBURG, ID 834405277

    Phone: (208) 881-5222

    Fax: (877) 441-4715

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 7 Open Payments records for all available years, with a total value of $134.

Total Amount is formed as General ($134) + Research ($0) + Ownership ($0) = $134.

Last reported payment date: 2024-09-18 • Largest payer in this snapshot: ABBVIE INC. ($35).

Total Amount

$134

General + Research + Ownership

Payments

7

Total payment records

General Amount

$134

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-18

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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: 2009-06-29

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20090629000517IFamily PracticeIDTBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes8551$0
36415Insertion of needle into vein for collection of blood sample4640$0
99214Established patient office or other outpatient visit, 30-39 minutes3931$0
83036Hemoglobin a1c level3828$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit3131$0
View full utilization report →

Insurance plans in this area (ZIP 83301)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4981846698View full group profile
NameSpecialtyState
Family PracticeID
Physician AssistantWA
Family PracticeID
Physician AssistantID
Physician AssistantKS
Physician AssistantID
Physician AssistantID

Reviews

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Frequently asked questions

Can I use this page to confirm KELLY L DUSTIN (DO)'s NPI?
Yes. KELLY L DUSTIN (DO) is listed with NPI 1114957362 in the public NPI dataset.
Is KELLY L DUSTIN (DO) listed as active for patients and plans?
The listing shows KELLY L DUSTIN (DO) as active in the NPI system.
What is KELLY L DUSTIN (DO)'s specialty?
The listing groups KELLY L DUSTIN (DO) with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is KELLY L DUSTIN (DO) based?
KELLY L DUSTIN (DO) is tied to Twin Falls, Idaho in the data we show; additional addresses may exist on the full record.
Why does KELLY L DUSTIN (DO) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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