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MR. RODERICK KELLY PA
NPI 1275637472
Physician Assistant in Fort Polk, LA

Active since September 11, 2006PECOS Enrolled
83.84/100
CMS Quality Rating
1585 3RD ST, FORT POLK, LA 71459(337) 531-3011 Get Directions Write a Review

NPPES record last updated: September 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 16, 2025, May 3, 2022 (2 updates tracked since 2022).

About Mr. Roderick Kelly Pa NPPES

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

MR. RODERICK KELLY PA (NPI 1275637472) is an individual physician assistant in Fort Polk, Louisiana, licensed in Texas (PA02232) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Beauregard Memorial Hospital, and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1275637472
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. RODERICK KELLYCredential: PA
Location Address1585 3RD STFort Polk, LA 71459-5102
Mailing Address1509 W Loop 281 Ste 2-bLongview, TX 75604-2820 · (903) 759-9355
Phone(337) 531-3011
Sole ProprietorNo
Medical School CMSOtherGraduated 2000
Enumeration DateSeptember 11, 2006
Last NPPES UpdateSeptember 16, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 16, 2025
✔ NPI 1275637472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses✔ Licensed in TX · PA02232✔ Licensed in LA · PA200615
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1585 3RD ST, Fort Polk, LA 71459
Open in Google Maps ↗

Secondary Practice Locations 3

Location 11549 E 70th St Ste 300Shreveport, LA 71105-5056 · Phone (318) 300-3898 · Fax (318) 797-4241
Location 21509 W Loop 281, Suite 2-BLongview, TX 75604-2820 · Phone (903) 759-9355
Location 3800 E Dawson StTyler, TX 75701-2036 · Phone (903) 606-4262

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, HMO Louisiana, Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Roderick Kelly Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6002912581
PECOS Enrollment IDI20070430000222, I20130725000750
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 6

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.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
66 services66 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
51 services51 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
32 services32 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
25 services25 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
18 services18 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
15 services15 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Beauregard Memorial Hospital

Acute Care Hospitals · Deridder, LA
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number190050
Location600 S Pine StreetDeridder, LA 70634 · Beauregard County
Emergency services Birthing friendly

St Francis Medical Center

Acute Care Hospitals · Monroe, LA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number190125
Location309 Jackson StreetMonroe, LA 71201 · Ouachita County
Emergency services Birthing friendly

Brownfield Regional Medical Center

Acute Care Hospitals · Brownfield, TX
OwnershipGovernment - Hospital District or Authority
CMS Certification Number450399
Location705 East Felt StreetBrownfield, TX 79316 · Terry County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 71459 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
$83.60 typical visit price
range $53.43 – $164.73
Typical copayment $20.90 (range $13.35 – $41.18)
Most-billed visit code 99203
Established Patient
$67.06 typical visit price
range $16.64 – $133.62
Typical copayment $16.76 (range $4.16 – $33.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.84/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality84.59
Promoting Interoperability100
Improvement Activities40
Cost58.63

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.

JEFFERY ALAN WHITE D.O.
Orthopaedic Surgery
1585 3RD ST
FORT POLK, LA 71459
Vernon Parish (337) 531-3896
DR. LINDSAY EDWARDS MUNCY M.D.
Internal Medicine
1585 3RD ST
FORT POLK, LA 71459
Vernon Parish (706) 787-6945
DR. ANNIKA ELAINE ZIMMERMAN AU.D.
Audiologist
1585 3RD ST
FORT JOHNSON, LA 71459
Vernon Parish (337) 531-2629
MARCO I MIRNICS DPT
Physical Therapist
1585 3RD ST
FORT JOHNSON, LA 71459
Vernon Parish (615) 609-1424
LILLIAN ROZANSKI KEPPINGER RD
Dietitian, Registered
1585 3RD ST
FORT JOHNSON, LA 71459
Vernon Parish (318) 451-6947
KIARA GLORIA YEATMAN SCHIEN DO
Pediatrics
1585 3RD ST
FORT POLK, LA 71459
Vernon Parish (726) 780-2385
GERARD TIFFAULT MD
Emergency Medicine
1585 3RD ST
FORT POLK, LA 71459
Vernon Parish (240) 351-9565
MARK BRADLEY
Social Worker (Clinical)
1585 3RD ST, BJACH
FORT POLK, LA 71459
Vernon Parish (337) 531-3942

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roderick Kelly's NPI number?

The NPI number for Roderick Kelly is 1275637472. It was assigned to this individual provider in the NPPES registry on September 11, 2006.

Where is Roderick Kelly located?

Roderick Kelly practices at 1585 3rd St, Fort Polk, LA 71459. The listed phone number is (337) 531-3011.

What is Roderick Kelly's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Roderick Kelly enrolled in Medicare?

Yes. Roderick Kelly is registered in the Medicare PECOS enrollment system.

What insurance does Roderick Kelly accept?

Health plans from Blue Cross and Blue Shield of Texas, HMO Louisiana and Oscar Insurance Company list Roderick Kelly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Roderick Kelly affiliated with any hospitals?

According to CMS data, Roderick Kelly is affiliated with Beauregard Memorial Hospital, St Francis Medical Center and Brownfield Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Roderick Kelly was last updated on September 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.