NPIMap

Individual provider Active NPI

Nikolett Kocsis, PA-C

  • Physician Assistant
  • Derby, CT
National Provider Identifier
1134599541
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-10790 Issued in NC
Practice address
78 Pershing Dr
Derby, CT 06418-1433
Phone
(035) 165-3072
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9109051 FL
Medical Physician Assistant 363AM0700X 3730 CT
Physician Assistant 363A00000X 0010-10790 NC Primary

Addresses

Primary practice location

78 Pershing Dr
Derby, CT 06418-1433

Mailing address

2928 Main St Ste 101
Glastonbury, CT 06033-1007
Phone (860) 430-1246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161222001539 CT Practitioner - Physician Assistant 2062715378 Reassigns benefits to 3 organizations
I20210330002137 NC Practitioner - Physician Assistant 2062715378 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Neil Group IncGroup PAC ID 2365581196, 19 clinicians

Practice addresses (Care Compare)

1399 Ashleybrook LN
Suite 100
Winston Salem, NC 27103-2961
Phone (336) 774-2194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9109051FLMDPhysician Assistant
0010-10790NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Neil Group, Inc CurrentSince Jun 10, 2023 Accepting new patients
Lawrence and Memorial Hospital, Inc. CurrentSince Apr 1, 2019 Accepting new patients
Iredell Physician Network LLC CurrentSince Sep 1, 2021 Accepting new patients
Iredell Physician Network, LLC CurrentSince Sep 1, 2021 Accepting new patients
Lawrence and Memorial Hospital, Inc. Emergency Medicine CurrentSince Apr 1, 2019 Accepting new patients
Mema SC LLC Emergency Medicine PastSince Oct 13, 2024 Accepting new patients

Locations

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

1301 Eastchester Dr
Ste 201
High Point, NC 27265

653 Bluefield Rd
Ste A
Mooresville, NC 28117
Phone (704) 360-6460

766 Hartness Rd
Statesville, NC 28677
Phone (704) 838-2182

1540 E Broad St
Statesville, NC 28625
Phone (704) 230-4382

1399 Ashleybrook Ln
Ste 100
Winston Salem, NC 27103
Phone (336) 446-9080

110 W Elm St
Yadkinville, NC 27055
Phone (336) 575-3747

Organizations & group practices 11

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": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1134599541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2928 MAIN ST STE 101",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060331007",
            "telephone_number": "860-430-1246",
            "fax_number": "203-905-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 PERSHING DR",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181433",
            "telephone_number": "035-165-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCSIS",
        "first_name": "NIKOLETT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109051",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "3730",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

Verify at the official NPI Registry.