Individual provider Active NPI

Kelly Annunziato, P.A

  • Physician Assistant
  • White Plains, NY
National Provider Identifier
1174939359
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
017661 Issued in NY
Practice address
210 Westchester Ave
White Plains, NY 10604-2901
Phone
(914) 682-6470
Fax
(914) 681-5264
NPI assigned
Jul 8, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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 017661 NY Primary

Addresses

Primary practice location

210 Westchester Ave
White Plains, NY 10604-2901

Mailing address

800 Westchester Ave Ste N715
Rye Brook, NY 10573-1369
Phone (914) 682-6470

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
I20170111001065 NY Practitioner - Physician Assistant 1355622077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Westchester Medical Group, P.CGroup PAC ID 6406752963, 410 clinicians

Practice addresses (Care Compare)

210 Westchester Ave
White Plains, NY 10604-2901
Phone (914) 682-0700

3030 Westchester Ave
Purchase, NY 10577-2574
Phone (914) 831-4100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Group, P.C. CurrentSince Sep 1, 2021 Accepting new patients
North Shore - Lij Medical PC CurrentSince Dec 4, 2016 Accepting new patients

Locations

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

300 Community Dr
Plandome, NY 11030

3030 Westchester Ave
Purchase, NY 10577
Phone (914) 682-6435

800 Westchester Ave
Ste N715
Rye Brook, NY 10573
Phone (914) 607-5730

210 Westchester Ave
White Plains, NY 10604
Phone (914) 681-3100

Networks

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

Interoperability endpoints

  • Direct secure messaging: kelly.annunziato.1@21260.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1174939359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WESTCHESTER AVE STE N715",
            "city": "RYE BROOK",
            "state": "NY",
            "postal_code": "105731369",
            "telephone_number": "914-682-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTCHESTER AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106042901",
            "telephone_number": "914-682-6470",
            "fax_number": "914-681-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANNUNZIATO",
        "first_name": "KELLY",
        "credential": "P.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-08",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.