KELLY WICKSTROM D.O.
NPI 1083092589
Internal Medicine - Critical Care Medicine in Tucson, AZ

Q: What is Kelly Wickstrom's NPI number?

The NPI number for Kelly Wickstrom is 1083092589. It was assigned to this individual provider in the NPPES registry on May 15, 2015.

Q: What is Kelly Wickstrom's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Critical Care Medicine, with taxonomy code 207RC0200X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Wickstrom was last updated on April 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 15, 2015PECOS EnrolledAccepts Medicare Assignment

5301 E GRANT RD, TUCSON, AZ 85712(520) 324-5696(520) 324-1583 Get Directions Write a Review

NPPES record last updated: April 29, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kelly Wickstrom D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY WICKSTROM D.O. (NPI 1083092589) is an individual critical care medicine provider in Tucson, Arizona, licensed in Arizona (008816) and active in the NPI registry since May 2015. She is enrolled in Medicare PECOS and is a graduate of Des Moines University Of Osteopathic Medicine And Health Sciences (2015).

NPPES Registry Identity

NPI1083092589

Entity TypeIndividualFemale

Primary Taxonomy207RC0200X

Provider Legal NameKELLY WICKSTROMCredential: D.O.

Location Address5301 E GRANT RDTucson, AZ 85712-2805

Mailing Address1501 N Campbell Ave Rm 6336, Box 245040Tucson, AZ 85724-5040 · (520) 626-7000 · Fax (520) 626-6020

Phone(520) 324-5696

Fax(520) 324-1583

Sole ProprietorNo

Medical School CMSDes Moines University Of Osteopathic Medicine And Health SciencesGraduated 2015

Enumeration DateMay 15, 2015

Last NPPES UpdateApril 29, 2023

NPPES CertifiedFebruary 10, 2023

✔ NPI 1083092589 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Critical Care MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207RC0200X

License✔ Licensed in AZ · 008816

Definition

An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.

Also ListedInternal MedicineTaxonomy 207R00000X · License 008816 (AZ), R2504 (AZ)

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X · License 008816 (AZ)

5301 E GRANT RD, Tucson, AZ 85712

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Other Identifiers 1

Medicaid088520AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Wickstrom D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729496914

PECOS Enrollment IDI20210428002394

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

22 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85712 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$127.71 typical visit price

range $55.44 – $168.60

Typical copayment $31.92 (range $13.86 – $42.15)

Most-billed visit code 99204

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HOLLY JEANNE GRAHAM M.D.

Anesthesiology

5301 E GRANT RD, THMEP
TUCSON, AZ 85712

Pima County (520) 324-5095

SAMANTHA PENN PHARMD

Pharmacist