MRS. KELLY HACKER (PA-C) – Physician Assistant, NPI 1104090208
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,797 PHYSICIAN ASSISTANT in OK
Loading map...
Provider Addresses for MRS. KELLY HACKER (PA-C)
200, Northeast 13th Street, Wagoner, Wagoner County, Oklahoma, 74467, United States
OKLAHOMA CITY, OK 731045051
Phone: (405) 627-1435
Fax: (405) 627-1869
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 27 Open Payments records for all available years, with a total value of $466.
Total Amount is formed as General ($466) + Research ($0) + Ownership ($0) = $466.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Amgen Inc. ($120).
Total Amount
$466
General + Research + Ownership
Payments
27
Total payment records
General Amount
$466
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
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: 2005-02-02
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 |
|---|---|---|---|---|
| I20050202000541 | I | Physician Assistant | OK | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 77 | 76 | $0 |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 35 | 23 | $0 |
| 99239 | Hospital discharge day management, more than 30 minutes | 28 | 26 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 20 | 16 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 19 | 19 | $0 |
Insurance plans in this area (ZIP 73104)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease | TN | |
| Cardiac Electrophysiology, Cardiovascular Disease (Cardiology) | OK | |
| Nurse Practitioner | OK | |
| Physician Assistant | OK | |
| - | OK | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | OK | |
| Nurse Practitioner | OK | |
| Vascular Surgery | OK | |
| Physician Assistant | OK | |
| - | OK |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.