KELLY PHOMMAHAXAY M.D.
NPI 1770997173
Family Medicine in La Mesa, CA
About Kelly Phommahaxay M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY PHOMMAHAXAY M.D. (NPI 1770997173) is an individual family medicine provider in La Mesa, California, licensed in Minnesota (59533) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2014).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelly Phommahaxay M.d. 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.
Medicare Billing Reassignments
2Medicare enrollment records show Kelly Phommahaxay reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
San Diego, CA 92120
- Reassigned Medicare billing, California enrollment
- 13,921 clinicians in this Medicare group
Hot Springs, SD 57747
- Reassigned Medicare billing, South Dakota enrollment
- 321 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91942 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 2
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
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.
LA MESA, CA 91942
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 Phommahaxay's NPI number?
The NPI number for Kelly Phommahaxay is 1770997173. It was assigned to this individual provider in the NPPES registry on June 13, 2014.
Where is Kelly Phommahaxay located?
Kelly Phommahaxay practices at 8080 Parkway Dr, La Mesa, CA 91942. The listed phone number is (619) 753-5115.
What is Kelly Phommahaxay's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Kelly Phommahaxay enrolled in Medicare?
Yes. Kelly Phommahaxay is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kelly Phommahaxay's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Phommahaxay reassigns Medicare benefits to 2 organizations: Southern California Permanente Medical Group (San Diego, CA) and Monument Health Network, Inc. (Hot Springs, SD). 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 Phommahaxay'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 Phommahaxay was last updated on January 18, 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 Phommahaxay, M.D. · NPI 1770997173
Family Medicine physician in La Mesa, California. Individual provider, active in the CMS NPPES registry since June 13, 2014.
## Identity
- **NPI:** 1770997173 (Entity type: Individual)
- **Enumerated:** June 13, 2014
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 59533 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 8080 PARKWAY DR, La Mesa, CA 91942-2104
- **Phone:** (619) 753-5115
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **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): Southern California Permanente Medical Group (NPI 1225060742, San Diego, CA); Monument Health Network, Inc. (NPI 1588185268, Hot Springs, SD) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2014
## Record status
- **NPPES last updated:** January 18, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1770997173) · Data from the CMS NPPES public registry.