Individual provider Active NPI

Lori Kelly, NP

  • Family Nurse Practitioner
  • Camillus, NY
National Provider Identifier
1013383223
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
339784 Issued in NY
Practice address
439 Hinsdale Rd
Camillus, NY 13031-1648
Phone
(315) 488-0996
NPI assigned
Aug 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 339784 NY Primary

Addresses

Primary practice location

439 Hinsdale Rd
Camillus, NY 13031-1648

Mailing address

436 Hinsdale Rd
Camillus, NY 13031-1648

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151022000685 NY Practitioner - Nurse Practitioner 7719296326 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Familycare Medical Group PCGroup PAC ID 5193639565, 110 clinicians

Practice addresses (Care Compare)

436 Hinsdale Rd
Camillus, NY 13031-1648
Phone (315) 488-0996

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Familycare Medical Group, PC CurrentSince Sep 1, 2015 Accepting new patients

Locations

436 Hinsdale Rd
Camillus, NY 13031
Phone (315) 488-0996

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

Interoperability endpoints

  • Direct secure messaging: lkelly@fcmg.medentdirect.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1013383223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 HINSDALE RD",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130311648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 HINSDALE RD",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130311648",
            "telephone_number": "315-488-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LORI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-12",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "339784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camillus, NY

Sources for this page

Verify at the official NPI Registry.