Individual provider Active NPI

Catherine C Shelly

  • Medical Physician Assistant
  • Allentown, PA
National Provider Identifier
1285797787
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
OA002441 Issued in PA
Practice address
250 Cetronia Rd
#3
Allentown, PA 18104-9147
Phone
(610) 395-8224
NPI assigned
Dec 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X OA002441 PA Primary

Addresses

Primary practice location

250 Cetronia Rd
#3
Allentown, PA 18104-9147

Mailing address

250 Cetronia Rd
#3
Allentown, PA 18104-9147
Phone (610) 395-8224

Other names 1

  • Catherine Samoylo Former name

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
I20041008001187 PA Practitioner - Physician Assistant 9931168416 Reassigns benefits to 1 organization

National Provider Directory

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

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": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314230400000",
    "number": "1285797787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CETRONIA RD",
            "address_2": "#3",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181049147",
            "telephone_number": "610-395-8224",
            "fax_number": "610-395-8227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CETRONIA RD",
            "address_2": "#3",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181049147",
            "telephone_number": "610-395-8224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLY",
        "first_name": "CATHERINE",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2011-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA002441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CATHERINE",
            "last_name": "SAMOYLO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.