Kali Renee Rutherford, PA is a medicare enrolled "Physician Assistant" in Jefferson Cty, Tennessee. She went to Lincoln Memorial University Medical Department and graduated in 2023 and has 3 years of diverse experience with area of expertise as Physician Assistant. Her current practice location is
1405 S Sizer Ave Ste A, Jefferson Cty, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(865) 690-3811.
Kali Renee Rutherford is licensed to practice in Tennessee (license number 5906) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1164275566.
Provider's Profile
| Full Name | Kali Renee Rutherford |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 3 Years |
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| Location | 1405 S Sizer Ave Ste A, Jefferson Cty, Tennessee |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Kali Renee Rutherford attended and graduated from Lincoln Memorial University Medical Department in 2023
NPI Data:
- NPI Number: 1164275566
- Provider Enumeration Date: 04/08/2024
- Last Update Date: 06/05/2026
Medicare PECOS Information:
- PECOS PAC ID: 2860965969
- Enrollment ID: I20260619001864
Medical Identifiers
Medical identifiers for Kali Renee Rutherford such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1164275566 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 363A00000X | Physician Assistant | 5906 (Tennessee) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kali Renee Rutherford allows following entities to bill medicare on her behalf.
| Entity Name | Tennessee Urology Associates, PLLC |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1669416442
PECOS PAC ID: 7618952706
Enrollment ID: O20040622001531 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kali Renee Rutherford is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kali Renee Rutherford, PA
10200 Grand Central Ave Ste 220,
Owings Mills, MD 21117-4366
Ph: (865) 690-3811 | Kali Renee Rutherford, PA
1405 S Sizer Ave Ste A,
Jefferson Cty, TN 37760-2421
Ph: (865) 690-3811 |
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