NPIMap

Individual provider Active NPI

Kyle Lance Holsted, PA

  • Surgical Physician Assistant
  • Lebanon, NH
National Provider Identifier
1306409818
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1492 Issued in NH
Practice address
1 Medical Center Drive
Department of Surgery
Lebanon, NH 03756-0001
Phone
(603) 650-8537
NPI assigned
Apr 19, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1492 NH Primary

Addresses

Primary practice location

1 Medical Center Drive
Department of Surgery
Lebanon, NH 03756-0001

Mailing address

1 Medical Center Drive
Department of Surgery
Lebanon, NH 03756-0001
Phone (603) 650-8537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191003001120 NH Practitioner - Physician Assistant 7113258203 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dartmouth-Hitchcock ClinicGroup PAC ID 4183537509, 1,445 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Lebanon, NH 03756-1000
Phone (603) 650-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1492NHMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 9, 2019 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Sep 9, 2019 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 9, 2019 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Sep 9, 2019 Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1306409818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-8537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLSTED",
        "first_name": "KYLE",
        "middle_name": "LANCE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NH",
            "license": "1492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.