Carly Lynn Kassa

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

4704297338 Issued in MI

Practice address

50 N Perry St
Pontiac, MI 48342-2217

Phone

(248) 338-5645

Fax

(248) 338-5547

NPI assigned

Jun 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Ghiath Tayeb MD PC

  • Gastroenterology Physician
  • Rochester Hills, MI
  • NPI 1780613919
  Medicare reassignment NPD
• Telemed Consultants PLLC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1699398347
  NPD (past)

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1083106140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 GRACE AVUENUE",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "48307",
            "telephone_number": "248-227-2897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N PERRY ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483422217",
            "telephone_number": "248-338-5645",
            "fax_number": "248-338-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSA",
        "first_name": "CARLY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704297338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karmo Aesthetic Center PC
• Firas R Karmo, M.D.
• Lara Karmo, PA-C
• Maha Karmo, DDS
• Vania Denise Kasgorgis, CRNA
• Safa S Kassab, M.D.
• Claudia Kassouf, DO
• Kiranpreet Kaur
• Jonah Kaveh
• Kay Robertson MD PC

• Gerontology Nurse Practitioner in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Gerontology Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.