Individual provider Active NPI

Lynette D George, PA-C

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1346572492
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3105 New England Thruway
Bronx, NY 10469-3141
Phone
(917) 378-3184
NPI assigned
Jan 31, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

3105 New England Thruway
Bronx, NY 10469-3141

Mailing address

3105 New England Thruway
Bronx, NY 10469-3141
Phone (917) 378-3184

Other names 1

  • Ms. Lynette D George Professional name

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL HTTPS://EPICPROXY-PUB.ET1089.EPICHOSTED.COM/FHIRPROXY/API/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL HTTPS://EPICPROXY-PUB.ET1089.EPICHOSTED.COM/FHIRPROXY/API/FHIR/RA/ Health Information Exchange (HIE)
Direct Messaging Address KRA9038@DIRECT.NYP.ORG Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20120404000556 NY Practitioner - Physician Assistant 8921268673 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013880NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 31, 2023 Accepting new patients
Montefiore Medical Center CurrentSince Jan 31, 2023 Accepting new patients
Kings Physician Services, PC CurrentSince Oct 3, 2022 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

506 6th St
Brooklyn, NY 11215
Phone (718) 780-3279

506 6th St
Ste B
Brooklyn, NY 11215
Phone (718) 780-3677

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: kra9038@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRPROXY/API/FHIR/DSTU2/
  • Direct secure messaging: lygeorge@montefioredirect.com

Organizations & group practices 4

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": "1264896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1346572492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 NEW ENGLAND THRUWAY",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104693141",
            "telephone_number": "917-378-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 NEW ENGLAND THRUWAY",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104693141",
            "telephone_number": "917-378-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "LYNETTE",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-31",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "HTTPS://EPICPROXY-PUB.ET1089.EPICHOSTED.COM/FHIRPROXY/API/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "506 6th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112153609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "HTTPS://EPICPROXY-PUB.ET1089.EPICHOSTED.COM/FHIRPROXY/API/FHIR/RA/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "506 6th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112153609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KRA9038@DIRECT.NYP.ORG",
            "affiliation": "N",
            "endpointDescription": "DIRECT ADDRESS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "DIRECT ADDRESS",
            "address_1": "506 6th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112153609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LYNETTE",
            "last_name": "GEORGE",
            "middle_name": "D",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.