Kimberly Ann Collen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005238-1 Issued in NY

Practice address

6 Wellness Way Ste 111
Latham, NY 12110-2156

Phone

(518) 213-0227

Fax

(518) 782-3816

NPI assigned

Mar 9, 2006

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

Other names 1

• Kimberly Ann Koenig Other name

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

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberlycollen@ccp.allscriptsdirect.net

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.

• Community Care Physicians, PLLC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1922048370

  NY

  Medicare reassignment Care Compare group
• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727

  NY, Physician Assistant

  Medicare reassignment NPD
• St. Peter'S Health Partners Medical Associates, P.C.

  • Multi-Specialty Clinic/Center
  • Albany, NY
  • NPI 1750626834

  NY, Physician Assistant

  Medicare reassignment NPD
• Community Care Physicians, PC

  • Family Medicine Physician
  • Latham, NY
  • NPI 1427320118
  NPD
• Community Care Physicians, PC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1023380714
  NPD (past)

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1104894724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 WELLNESS WAY STE 201",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102156",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 WELLNESS WAY STE 111",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102156",
            "telephone_number": "518-213-0227",
            "fax_number": "518-782-3816"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 Vandenburgh Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121806024",
            "country_code": "US",
            "telephone_number": "518-286-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Empire Dr",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "NY",
            "postal_code": "121445730",
            "country_code": "US",
            "telephone_number": "518-286-4960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "724 Watervliet Shaker Rd",
            "address_purpose": "LOCATION",
            "city": "Latham",
            "state": "NY",
            "postal_code": "121103528",
            "country_code": "US",
            "telephone_number": "518-783-0312",
            "fax_number": "518-782-7485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Tallow Wood Dr",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120652807",
            "country_code": "US",
            "telephone_number": "518-373-4444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 Massachusetts Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121801628",
            "country_code": "US",
            "telephone_number": "518-268-5234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "377 Church St",
            "address_purpose": "LOCATION",
            "city": "Saratoga Springs",
            "state": "NY",
            "postal_code": "128668641",
            "country_code": "US",
            "telephone_number": "518-584-4456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLEN",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005238-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "KOENIG",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Colonie ASC LLC
• Maria A Commisso-Logan, DPT, PT
• Community Care Physicians

• All providers in Latham, NY
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.