Individual provider Active NPI

Elizabeth Anne Kiss, DNP, FNP

  • Family Nurse Practitioner
  • Fairport, NY
National Provider Identifier
1104238831
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
338401 Issued in NY
Practice address
79 County Clare Cres
Fairport, NY 14450-9179
Phone
(585) 943-4908
NPI assigned
May 29, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2014

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 338401 NY Primary

Addresses

Primary practice location

79 County Clare Cres
Fairport, NY 14450-9179

Mailing address

79 County Clare Cres
Fairport, NY 14450-9179
Phone (585) 943-4908

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
I20251209000658 NY Practitioner - Nurse Practitioner 1355658345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

601 Elmwood Ave Box
Rochester, NY 14642-0001

601 Elmwood Ave Med
Rochester, NY 14642-0001

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Group CurrentSince Oct 17, 2025 Accepting new patients
Internal Medicine Group CurrentSince Oct 17, 2025 Accepting new patients

Locations

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1104238831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 COUNTY CLARE CRES",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509179",
            "telephone_number": "585-943-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 COUNTY CLARE CRES",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509179",
            "telephone_number": "585-943-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISS",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "338401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairport, NY

Sources for this page

Verify at the official NPI Registry.