Melanie Jean Koumentakos, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001905 Issued in CT

Practice address

200 Silver St Unit 106
Agawam, MA 01001-3067

Phone

(413) 341-5350

Fax

(413) 341-5335

NPI assigned

Jul 30, 2007

Last updated

Apr 13, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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, 1996

Medicare assignment

May accept Medicare assignment

Group practices

Hillside Dermatology PCGroup PAC ID 3971983073, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Hillside Dermatology PC

  • Dermatology Physician
  • Agawam, MA
  • NPI 1669126546
  Medicare reassignment Care Compare group
• Riverbend Medical Group, Inc.

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1841651197
  Medicare reassignment NPD
• Riverbend Medical Group, Inc

  dba Trinity Health Of New England Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Springfield, MA
  • NPI 1265023154
  NPD

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776038400000",
    "number": "1295925956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SILVER ST UNIT 106",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010013067",
            "telephone_number": "413-341-5350",
            "fax_number": "413-341-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SILVER ST UNIT 106",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010013067",
            "telephone_number": "413-341-5350",
            "fax_number": "413-341-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUMENTAKOS",
        "first_name": "MELANIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-30",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kennedy
• Colleen Amelia King
• Kyla Lee Ann Kissinger, COTA/L
• Kristen Ann Kocot, M.A., LMHC
• Constance Elaine Kononitz, MSW
• Joel Krutt, M.A.
• Leona Lafleur
• Emily Laliberte
• Landmark Recovery of Massachusetts LLC
• Katelyn Landry, ATC

• Physician Assistant in Agawam, MA
• Providers in Agawam, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2026; 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.