Individual provider Active NPI

Kyra Braun, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1174147698
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA063521 Issued in PA
Practice address
1516 Locust St
Philadelphia, PA 19102-4409
Phone
(610) 525-5250
NPI assigned
Jun 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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
Physician Assistant 363A00000X PAO1232 RI
Medical Physician Assistant 363AM0700X MA063521 PA Primary

Addresses

Primary practice location

1516 Locust St
Philadelphia, PA 19102-4409

Mailing address

569 W Lancaster Ave
Haverford, PA 19041-1416
Phone (610) 525-5250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220701000207 PA Practitioner - Physician Assistant 8820417389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ringpfeil Advanced Dermatology PCGroup PAC ID 8022015486, 13 clinicians

Practice addresses (Care Compare)

569 W Lancaster Ave
Haverford, PA 19041-1416
Phone (610) 525-5250

Merit-based Incentive Payment System (MIPS)

Final score
97.25 of 100Reported as group
Quality
95
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PAO1232RIMDPhysician Assistant
MA063521PAMDMedical Physician Assistant

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCDCAA

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1174147698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 W LANCASTER AVE",
            "city": "HAVERFORD",
            "state": "PA",
            "postal_code": "190411416",
            "telephone_number": "610-525-5250",
            "fax_number": "610-525-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 LOCUST ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191024409",
            "telephone_number": "610-525-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUN",
        "first_name": "KYRA",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2024-01-30",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PAO1232",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA063521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.