Individual provider Active NPI

Kathleen M Lynch, DPM

  • Foot Surgery Podiatrist
  • Fayetteville, NY
National Provider Identifier
1134179740
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
N004991 Issued in NY
Practice address
512 Towne Dr
Fayetteville, NY 13066-1331
Phone
(315) 637-5500
Fax
(315) 637-5588
NPI assigned
May 12, 2006
Last updated
Jan 27, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X N004991 NY Primary

Addresses

Primary practice location

512 Towne Dr
Fayetteville, NY 13066-1331

Mailing address

512 Towne Dr
Fayetteville, NY 13066
Phone (315) 637-5500

Other identifiers 1

IdentifierTypeStateIssuer
01680491MedicaidNY

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090730000433 NY Practitioner - Podiatry 6103720651

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4991NYMDAddiction (Substance Use Disorder) Counselor
N004991NYMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Westside Podiatry Center LLP Foot Surgery PastSince Aug 18, 2008 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1134179740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 TOWNE DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-637-5500",
            "fax_number": "315-637-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 TOWNE DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661331",
            "telephone_number": "315-637-5500",
            "fax_number": "315-637-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N004991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01680491",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.