Kaly R Macconnell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA054607 Issued in PA

Practice address

1709 N Broad St
Lansdale, PA 19446-1115

Phone

(215) 362-5555

Fax

(215) 362-6353

NPI assigned

Oct 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kaly R Lutz Former name

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pennsylvania Dermatology Partners IncGroup PAC ID 3274794268, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmacconnell@pennderm.emadirect.md

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.

• Pennsylvania Dermatology Partners Inc

  • Dermatology Physician
  • West Lawn, PA
  • NPI 1023382918
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1295045474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 N BROAD ST",
            "city": "LANSDALE",
            "state": "PA",
            "postal_code": "194461115",
            "telephone_number": "215-362-5555",
            "fax_number": "215-362-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 N BROAD ST",
            "city": "LANSDALE",
            "state": "PA",
            "postal_code": "194461115",
            "telephone_number": "215-362-5555",
            "fax_number": "215-362-6353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 S Bryn Mawr Ave Ste H321",
            "address_purpose": "LOCATION",
            "city": "Bryn Mawr",
            "state": "PA",
            "postal_code": "19010",
            "country_code": "US",
            "telephone_number": "484-337-4097",
            "fax_number": "484-337-4082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1259 S Cedar Crest Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Allentown",
            "state": "PA",
            "postal_code": "181036373",
            "country_code": "US",
            "telephone_number": "610-437-4134",
            "fax_number": "610-433-9690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5458 Ridge Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191283732",
            "country_code": "US",
            "telephone_number": "215-487-1887",
            "fax_number": "215-487-1818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "385 Oxford Valley Rd Ste 420",
            "address_purpose": "LOCATION",
            "city": "Yardley",
            "state": "PA",
            "postal_code": "190677723",
            "country_code": "US",
            "telephone_number": "215-321-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACCONNELL",
        "first_name": "KALY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-20",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA002538",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA054607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALY",
            "last_name": "LUTZ",
            "middle_name": "R",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marianne Luquet, MSW, LCSW
• Christine H Lutz, CRNA
• Luxottica of America Inc
• Bridget Clare Lynch
• Bruce Macartney, RPH
• Deborah Macdonagh, MA
• Jacqueline Bassett Mackey, M.D.
• Mark E Mackey, LMT, CNMT, CST
• Erica Lynne Madge, LPC, CAADC
• Nisreen Mousa Madhoun, DO

• Medical Physician Assistant in Lansdale, PA
• Providers in Lansdale, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.