NICOLE M. KELLNER (PA) – Physician Assistant, NPI 1245581677
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
4,429 PHYSICIAN ASSISTANT in VA
Provider Addresses for NICOLE M. KELLNER (PA)
9460 AMBERDALE DR STE D
NORTH CHESTERFIELD, VA 232361259
Phone: (804) 533-0220
Fax: (804) 533-0230
Type: Location
PO BOX 402924
ATLANTA, GA 303842924
Phone: (804) 320-2705
Fax: (804) 330-2433
Type: Mailing
6920 POINTE INVERNESS WAY STE 200
FORT WAYNE, IN 468047934
Phone: (260) 479-3514
Fax: (260) 479-3520
Type: Mailing
7900 W JEFFERSON BLVD STE 306
FORT WAYNE, IN 468044128
Phone: (260) 479-3514
Fax: (260) 479-3520
Type: Location
40 MEDICAL PARK BLVD
SUITE A
PETERSBURG, VA 238059289
Phone: (804) 520-6730
Fax: (804) 520-6731
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $69.
Total Amount is formed as General ($69) + Research ($0) + Ownership ($0) = $69.
Last reported payment date: 2024-10-01 • Largest payer in this snapshot: Intuitive Surgical, Inc. ($19).
Total Amount
$69
General + Research + Ownership
Payments
4
Total payment records
General Amount
$69
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-01
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Intuitive Surgical, Inc. | $19 |
| Kerecis Limited | $18 |
| W. L. Gore & Associates, Inc. | $16 |
| Aroa Biosurgery Incorporated | $16 |
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: 2023-09-14
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 |
|---|---|---|---|---|
| I20230914003527 | I | Physician Assistant | IN | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 17 | 13 | $0 |
Insurance plans in this area (ZIP 23236)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Infectious Disease | IN | |
| - | IN | |
| Family Practice | IN | |
| Nurse Practitioner | IN | |
| U R O L O G Y | MI | |
| Internal Medicine | IN | |
| - | IN | |
| Nurse Practitioner | IN | |
| Cardiovascular Disease (Cardiology) | IN | |
| Family Practice | IN |
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