Individual provider Active NPI

Kayla Fraser-Davis

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1104582063
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3201 Kings Hwy
Brooklyn, NY 11234-2625
Phone
(718) 252-3000
NPI assigned
Nov 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

3201 Kings Hwy
Brooklyn, NY 11234-2625

Mailing address

3201 Kings Hwy
Brooklyn, NY 11234-2625
Phone (718) 252-3000

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
I20230927001167 NY Practitioner - Physician Assistant 6901250844 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
030343NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based CurrentSince Jul 31, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 15, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 15, 2023 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

3201 Kings Hwy
Brooklyn, NY 11234
Phone (718) 252-3000

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

234 E 85th St
New York, NY 10028
Phone (212) 241-6585

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: kfraserdavis1853379@nychhc.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1104582063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342625",
            "telephone_number": "718-252-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112342625",
            "telephone_number": "718-252-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER-DAVIS",
        "first_name": "KAYLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-15",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.