Individual provider Active NPI

Kelley Hull, PA-C

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1184408965
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
030373 Issued in NY
Practice address
739 Irving Ave Ste 400
Syracuse, NY 13210-1655
Phone
(315) 234-6677
NPI assigned
Aug 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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 030373 NY Primary

Addresses

Primary practice location

739 Irving Ave Ste 400
Syracuse, NY 13210-1655

Mailing address

312 Hourglass LN
Baldwinsville, NY 13027-9681

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
I20231109001587 NY Practitioner - Physician Assistant 9032566237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5000 Campuswood Dr
Suite 200
East Syracuse, NY 13057-1268
Phone (315) 234-6677

5415 W Genesee St
Suite 203
Camillus, NY 13031-2162
Phone (315) 324-6677

739 Irving Ave
Suite 430
Syracuse, NY 13210-1653
Phone (315) 234-6677

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.09 of 100Reported as group
Quality
97.07
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Syracuse Gastroenterological Associates PC CurrentSince Sep 16, 2023 Accepting new patients

Locations

5000 Campuswood Dr
Ste 200
East Syracuse, NY 13057

8324 Oswego Rd
Ste 203
Liverpool, NY 13090
Phone (315) 641-1966

739 Irving Ave
Ste 430
Syracuse, NY 13210

739 Irving Ave
Ste 400
Syracuse, NY 13210
Phone (315) 234-4815

Organizations & group practices 2

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 4

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": "1692662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1184408965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 HOURGLASS LN",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101655",
            "telephone_number": "315-234-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULL",
        "first_name": "KELLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.