MRS. KELLY LEIGH MACK (PA-C) – Medical Physician Assistant, NPI 1396813960
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,365 PHYSICIAN ASSISTANT in MD
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Provider Addresses for MRS. KELLY LEIGH MACK (PA-C)
4505, Kingwood Drive, Kingwood, Houston, Harris County, Texas, 77345, United States
STE 185
KINGWOOD, TX 773452618
Phone: (281) 747-5533
Fax: (281) 747-5534
Type: Mailing
Prince Frederick Boulevard, The Knolls, Prince Frederick, Calvert County, Maryland, 20678, United States
SUITE 204
PRINCE FREDERICK, MD 20678
Phone: (410) 535-5855
Fax: (410) 535-6574
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 367 Open Payments records for all available years, with a total value of $7,019.
Total Amount is formed as General ($7,019) + Research ($0) + Ownership ($0) = $7,019.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Janssen Biotech, Inc. ($881).
Total Amount
$7,019
General + Research + Ownership
Payments
367
Total payment records
General Amount
$7,019
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
| Company | Amount |
|---|---|
| Janssen Biotech, Inc. | $881 |
| Lilly USA, LLC | $773 |
| SUN PHARMACEUTICAL INDUSTRIES INC. | $548 |
| Regeneron Healthcare Solutions, Inc. | $294 |
| LEO Pharma Inc. | $282 |
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: 2012-04-18
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 |
|---|---|---|---|---|
| I20120418000343 | I | Physician Assistant | TX | 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 |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 348 | 56 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 107 | 83 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 107 | 76 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 86 | 76 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 75 | 63 | $0 |
Insurance plans in this area (ZIP 77345)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | TX | |
| D E R M A T O L O G Y | TX | |
| D E R M A T O L O G Y | MA | |
| Physician Assistant | TX | |
| Pathology, Dermatology | AL | |
| D E R M A T O L O G Y | NC | |
| Micrographic Dermatologic Surgery (Mds) | TX | |
| Physician Assistant | TX | |
| D E R M A T O L O G Y | TX | |
| Physician Assistant | TX |
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