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Active NPI 1922393974 Individual Practitioner Male Practitioner

Dr. Randall Douglas Kelly , MHS, DMSC, PA-C

Physician Assistant • Hermiston, OR

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Randall Kelly, MHS, DMSC, PA-C is a certified Physician Assistant practicing in Hermiston, OR. With approximately 16 years of clinical experience since completing medical education in 2010, Dr. Kelly delivers high-quality medical care to the local community at 256 E HURLBURT AVE STE 117.

Dr. Kelly is affiliated with Oregon Washington Health Network and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include measurement of alcohol level in breath specimen, telehealth originating site facility fee, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

256 E Hurlburt Ave Ste 117

Hermiston, OR 978382443

Telephone 5413033558
Fax 5095934644
Associated Practice Facility / Clinic
🏢 New Life Wellness Llc Facility NPI 1508463639

Medicare Profile & Education

Medical School

Other

Graduation Year

2010

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Hermiston, OR

Established Specialist (10-20 Yrs)
Practitioner Clinical Experience
16 Yrs +7.1 yrs vs City Avg
City Avg: 8.9 Yrs
State Avg: 10.5 Yrs
Regional Practice Density
17 Specialists

Practicing in Hermiston, OR (2106 Statewide)

Telehealth Adoption Rate
11.8% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount
45.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Kelly (16 Years) 16 Yrs
Hermiston Specialty Average (8.9 Years) 8.9 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
82075 Measurement of alcohol level in breath specimen
167 11 $49.13 $29.33
Q3014 Telehealth originating site facility fee
161 11 $55.00 $27.29

Medical Specialties & State Licenses

CMS Verified: 2026-03-27
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License OR PA184529

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.

Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

State License OR 184529

Definition to come...

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License OR PA184529

Definition to come...

Preventive Medicine - Addiction Medicine

NUCC Taxonomy Code: 2083A0300X

State License OR PA184529

A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.

Physician Assistant

NUCC Taxonomy Code: 363A00000X

State License WA PA60205772

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.

Preventive Medicine - Addiction Medicine

NUCC Taxonomy Code: 2083A0300X

State License WA PA60205772

A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
2013576 (WA)
Commercial Insurance / Payer ID Labor & Industries
0281857 (WA)

Hospital & Practice Group Affiliations

Oregon Washington Health Network

715 Sw Dorion Ave, Pendleton, OR 978012070

Phone: 5414298844

Secondary Practice Locations

278 E High St Ste 209

Stayton, OR 973831788

Phone: 5413033558

71 Centennial Loop Ste A

Eugene, OR 974012443

Phone: 5413033558

761 Main St

Dallas, OR 973383108

Phone: 5413033558

1901 Garden Ave Ste 210

Eugene, OR 974034301

Phone: 5413033558

2900 Nw Clearwater Dr

Bend, OR 977039410

Phone: 5413033558

1817 Ne 6th Ave

Portland, OR 972123960

Phone: 5413033558

1110 Se Alder St Ste 301

Portland, OR 972142400

Phone: 5413033558

4909 S Coast Hwy Ste 1k

South Beach, OR 973669667

Phone: 5413033558

124 W Kennewick Ave Ste 11

Kennewick, WA 993363830

Phone: 5413033558

520 Nw 4th St

Corvallis, OR 973306411

Phone: 5413033558

1345 Nw 15th St

Lincoln City, OR 973673327

Phone: 5413033558

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Mindy Tanimoto , ARNP

Nurse Practitioner - Family

NPI 1043767122

Advanced Registered Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

24 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 27, 2026

Counselor (License #184529 in OR)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 14, 2025

Physician Assistant (License #PA184529 in OR)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 02, 2025

Physician Assistant (License #PA184529 in OR)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 19, 2025

Counselor (License #184529 in OR)

👤
Provider Name / Credentials Updated August 10, 2024

Recorded as RANDALL KELLY, MHS, DMSC, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 10, 2024

Preventive Medicine (License #PA184529 in OR)

📍
Updated Practice Location October 27, 2023

Registered at 256 E HURLBURT AVE STE 117, HERMISTON, OR 978382443 (Tel: 5413519150)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 27, 2023

Preventive Medicine (License #PA60205772 in WA)

👤
Provider Name / Credentials Updated July 08, 2023

Recorded as RANDALL KELLY, PA-C, DMSC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2023

Preventive Medicine (License #PA184529 in OR)

📍
Updated Practice Location August 18, 2022

Registered at 5601 CONCORD DR, PASCO, WA 993015462 (Tel: 2064188222)

📍
Updated Business Mailing Address August 18, 2022

Registered at 5426 ROAD 68 STE D253, PASCO, WA 993015268 (Tel: 2064188222)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 18, 2022

Preventive Medicine (License #PA60205772 in WA)

📍
Updated Practice Location September 30, 2019

Registered at 114 E 16TH AVE, EUGENE, OR 974014033 (Tel: 5417902455)

📍
Updated Business Mailing Address September 30, 2019

Registered at 114 E 16TH AVE, EUGENE, OR 974014033 (Tel: 5417902455)

📍
Updated Practice Location June 25, 2018

Registered at 1710 DOUGLAS DR N STE 225V, GOLDEN VALLEY, MN 55422 (Tel: 8775221275)

📍
Updated Business Mailing Address June 25, 2018

Registered at 5615 DUNBARTON AVE, PASCO, WA 993018216 (Tel: 5092221275)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 25, 2018

Physician Assistant

NPI Profile Active February 05, 2015

NPI status registered as active in NPPES database

📍
Updated Practice Location February 05, 2015

Registered at 19020 33RD AVE W, SUITE 210, LYNNWOOD, WA 980364746 (Tel: 4255631500)

📍
Updated Business Mailing Address February 05, 2015

Registered at 19020 33RD AVE W, SUITE 210, LYNNWOOD, WA 980364746 (Tel: 4255631500)

👤
Provider Name / Credentials Updated February 05, 2015

Recorded as RANDALL KELLY, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 05, 2015

Physician Assistant (License #PA60205772 in WA)

🟢
Initial NPI Registration & Enumeration June 16, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1922393974
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 16, 2011
Last Update: March 27, 2026
Sole Proprietor: No

Mailing Address

5426 Road 68 Ste D253

Pasco, WA 993015268

Phone: 5413033558

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.