Individual provider Active NPI

Kimberly S Trent, PA

  • Surgical Physician Assistant
  • Syracuse, NY
National Provider Identifier
1053484535
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
008402 Issued in NY
Practice address
301 Prospect Ave
Syracuse, NY 13203-1807
Phone
(315) 448-5111
Fax
(315) 703-5079
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 008402 NY Primary

Addresses

Primary practice location

301 Prospect Ave
Syracuse, NY 13203-1807

Mailing address

104 Union Ave
Suite 804
Syracuse, NY 13203-1843
Phone (315) 703-5049

Other names 1

  • Kimberly A Santas Former name

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
I20101028000261 NY Practitioner - Physician Assistant 0446444095 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
008402NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph'S Hospital Health Center Surgical CurrentSince Jan 1, 2002 Accepting new patients
St. Joseph'S Pathology, PC Current Accepting new patients
North Medical PC Past Accepting new patients
University Surgical Associates, LLP Past Accepting new patients

Locations

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

Interoperability endpoints

  • Direct secure messaging: ktrent2389119@direct.trinity-health.org

Organizations & group practices 7

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 1

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1053484535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 UNION AVE",
            "address_2": "SUITE 804",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132031843",
            "telephone_number": "315-703-5049",
            "fax_number": "315-703-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PROSPECT AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132031807",
            "telephone_number": "315-448-5111",
            "fax_number": "315-703-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRENT",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "008402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SANTAS",
            "middle_name": "A",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.