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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KELLY DISTASIO
NPI 1801639554
Physician Assistant in Clinton, MD

Active since June 18, 2024PECOS EnrolledAccepts Medicare Assignment
7503 SURRATTS RD, CLINTON, MD 20735(301) 877-7202 Get Directions Write a Review

NPPES record last updated: August 14, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 14, 2026, Nov 22, 2025, Jun 18, 2024 (3 updates tracked since 2024).

About Kelly Distasio NPPES

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

KELLY DISTASIO (NPI 1801639554) is an individual physician assistant in Clinton, Maryland, licensed in Virginia (0110011392) and active in the NPI registry since June 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1801639554
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKELLY DISTASIO
Location Address7503 SURRATTS RDClinton, MD 20735-3358
Mailing Address7501 Surratts Rd, Pob Suite 303Clinton, MD 20735-3362
Phone(301) 877-7202
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateJune 18, 2024
Last NPPES UpdateAugust 14, 20263 updates tracked since enumeration
NPPES CertifiedAugust 14, 2026
✔ NPI 1801639554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in VA · 0110011392
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.
7503 SURRATTS RD, Clinton, MD 20735
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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 Distasio 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 ID4082180831
PECOS Enrollment IDI20260418000417
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20735 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
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$80.66 typical visit price
range $21.40 – $158.88
Typical copayment $20.16 (range $5.35 – $39.72)
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.

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.

PEDIATRIX OF MARYLAND PA
Pediatrics (Neonatal-Perinatal Medicine)
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (301) 868-8000
MRS. BRITTANY REGINA KELLY MS, CCC-SLP
Speech-Language Pathologist
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (860) 336-8078
DR. GISELLE TRICIA BURNETT-HEADLEY M.D.
Pediatrics
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (301) 877-4288
LATYRA GIBBS MD
Obstetrics & Gynecology
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (301) 868-8000
LESLIE COVINGTON FINCHER PA-C
Physician Assistant
7503 SURRATTS RD, EMERGENCY DEPT, MEDSTAR SOUTHERN MARYLAND HOSPITAL
CLINTON, MD 20735
Prince George's County (301) 877-4500
RUI HONG
Nurse Anesthetist, Certified Registered
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (301) 235-9078
MISS IVANNA PLYMOUTH NP
Nurse Practitioner (Critical Care Medicine)
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (301) 877-4656
DR. JENNIFER APPIAH
Hospitalist
7503 SURRATTS RD
CLINTON, MD 20735
Prince George's County (703) 537-9677

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 Distasio's NPI number?

The NPI number for Kelly Distasio is 1801639554. It was assigned to this individual provider in the NPPES registry on June 18, 2024.

Where is Kelly Distasio located?

Kelly Distasio practices at 7503 Surratts Rd, Clinton, MD 20735. The listed phone number is (301) 877-7202.

What is Kelly Distasio's specialty?

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

Is Kelly Distasio enrolled in Medicare?

Yes. Kelly Distasio 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.

When was this NPI record last updated?

The NPPES record for Kelly Distasio was last updated on August 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days 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.