Kevin Anthony Pelletier, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA8182 Issued in MA

Practice address

100 Wason Ave Ste 120
Springfield, MA 01107-1179

Phone

(413) 241-2100

NPI assigned

Dec 3, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, CT2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pioneer Valley Urology, PCGroup PAC ID 7214972207, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baystate Medical Center Hospital, Springfield, MA, CCN 220077
• Cooley Dickinson Hospital Inc,the Hospital, Northampton, MA, CCN 220015
• Baystate Franklin Medical Center Hospital, Greenfield, MA, CCN 220016
• Baystate Noble Hospital Hospital, Westfield, MA, CCN 220065
• Baystate Wing Hospital Hospital, Palmer, MA, CCN 220030

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Pioneer Valley Urology, PC

  • Urology Physician
  • Springfield, MA
  • NPI 1750315982

  CT

  Medicare reassignment Care Compare group
• Radiology & Imaging, Inc.

  • Diagnostic Radiology Physician
  • Springfield, MA
  • NPI 1790731008
  NPD (past)

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

• Baystate Franklin Medical Center

  • General Acute Care Hospital
  • Greenfield, MA
  • NPI 1508867391
  Care Compare affiliation
• Baystate Medical Center Inc

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1487655064
  Care Compare affiliation
• Baystate Medical Center Inc

  • Clinical Medical Laboratory
  • Springfield, MA
  • NPI 1568488450

  Hospital

  Care Compare affiliation
• Baystate Noble Hospital Corporation

  • General Acute Care Hospital
  • Westfield, MA
  • NPI 1700816048
  Care Compare affiliation
• Baystate Wing Hospital Corporation

  • General Acute Care Hospital
  • Palmer, MA
  • NPI 1962410233
  Care Compare affiliation
• Cooley Dickinson Hospital Inc

  • General Acute Care Hospital
  • Northampton, MA
  • NPI 1477596310
  Care Compare affiliation
• Cooley Dickinson Hospital Inc

  • Psychiatric Hospital Unit
  • Northampton, MA
  • NPI 1871512814
  Care Compare affiliation

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1194362632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WASON AVE STE 120",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071179",
            "telephone_number": "413-272-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WASON AVE STE 120",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071179",
            "telephone_number": "413-241-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETIER",
        "first_name": "KEVIN",
        "middle_name": "ANTHONY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-03",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8182",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA8182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salvatore Pellegrino, RN
• Amber Marie Pelletier, OTR/L
• Amy L Pelletier, D.O.
• Casey Pelletier, LMHC
• George A Pelletier, M.D.
• Summer Rose Pelletier
• Brian Thomas Pellicano, PA
• Elizabeth Lara Peloquin, FNP-BC
• Mathieu Ryan Peloquin, CRC
• Jean Pelski, PHD, APRN, NNP-BC

• Medical Physician Assistant in Springfield, MA
• Providers in Springfield, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.