Individual provider Active NPI

Kaylan C McDowell-Smith, PA-C

  • Surgical Physician Assistant
  • Derby, CT
National Provider Identifier
1255789129
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
3714 Issued in CT
Practice address
130 Division St
Derby, CT 06418-1326
Phone
(203) 732-1330
Fax
(203) 732-1332
NPI assigned
Jun 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X 3714 CT Primary

Addresses

Primary practice location

130 Division St
Derby, CT 06418-1326

Mailing address

67 Maple Ave
Derby, CT 06418-1328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20170203001914 CT Practitioner - Physician Assistant 5496038150 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MHS Primary Care, Inc.Group PAC ID 4082507371, 180 clinicians

Practice addresses (Care Compare)

14 Jones Hollow Rd
Suite 2
Marlborough, CT 06447-1448
Phone (860) 358-2850

28 Crescent St
Middletown, CT 06457-3654

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3714CTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MHS Primary Care Inc CurrentSince May 15, 2017 Accepting new patients
Hartford Healthcare Medical Group, Inc CurrentSince Jan 1, 2017 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Jun 1, 2020 Accepting new patients
MHS Primary Care Inc. Surgical CurrentSince May 15, 2017 Accepting new patients
MHS Primary Care, Inc Past Accepting new patients

Locations

130 Division St
Derby, CT 06418
Phone (203) 732-1330

14 Jones Hollow Rd
Ste 2
Marlborough, CT 06447

540 Saybrook Rd
Ste 100B
Middletown, CT 06457
Phone (860) 347-6683

540 Saybrook Rd
#S100
Middletown, CT 06457

520 Saybrook Rd
Ste S100
Middletown, CT 06457
Phone (860) 346-2608

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

Interoperability endpoints

  • Direct secure messaging: kmcdowellsmith11434@middlesexhealthprd.direct-ci.com
  • Direct secure messaging: kaylan.mcdowell-smith@xdr.hhchealthdirect.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1255789129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DIVISION ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181326",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDOWELL-SMITH",
        "first_name": "KAYLAN",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-01",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "3714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

Verify at the official NPI Registry.