KELLY ANNE FEDORUK MD
NPI 1568093045
Anesthesiology in Palo Alto, CA
About Kelly Anne Fedoruk Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY ANNE FEDORUK MD (NPI 1568093045) is an individual anesthesiology provider in Palo Alto, California, licensed in California (A144015) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS and maintains a secondary practice location in Stanford.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Anne Fedoruk Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Kelly Fedoruk reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Palo Alto, CA 94304
- Reassigned Medicare billing, California enrollment
- 3,617 clinicians in this Medicare group
Stanford, CA 94305
- Reassigned Medicare billing, California enrollment
- 4,258 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
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 Kelly Fedoruk's NPI number?
The NPI number for Kelly Fedoruk is 1568093045. It was assigned to this individual provider in the NPPES registry on February 3, 2020.
Where is Kelly Fedoruk located?
Kelly Fedoruk practices at 725 Welch Rd, Palo Alto, CA 94304. The listed phone number is (650) 497-8000.
What is Kelly Fedoruk's specialty?
The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.
Is Kelly Fedoruk enrolled in Medicare?
Yes. Kelly Fedoruk is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Kelly Fedoruk's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Fedoruk reassigns Medicare benefits to 2 organizations: Lpch Medical Group Div Of Lucile (Palo Alto, CA) and Stanford Health Care (Stanford, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Fedoruk's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Fedoruk was last updated on April 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Kelly Anne Fedoruk, MD · NPI 1568093045
Anesthesiology physician in Palo Alto, California. Individual provider, active in the CMS NPPES registry since February 3, 2020.
## Identity
- **NPI:** 1568093045 (Entity type: Individual)
- **Enumerated:** February 3, 2020
- **Primary specialty:** Anesthesiology · taxonomy 207L00000X
- **State license:** A144015 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 725 WELCH RD, Palo Alto, CA 94304-1601
- **Phone:** (650) 497-8000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Lpch Medical Group Div Of Lucile (NPI 1417907940, Palo Alto, CA); Stanford Health Care (NPI 1437292927, Stanford, CA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 10, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1568093045) · Data from the CMS NPPES public registry.