Individual provider Active NPI

Raymond Joseph Kelly, PA-C

  • Physician Assistant
  • East Hills, NY
National Provider Identifier
1376038695
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022111 Issued in NY
Practice address
2200 Northern Blvd Ste 121
East Hills, NY 11548-1220
Phone
(516) 705-1044
NPI assigned
Jun 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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 022111 NY Primary

Addresses

Primary practice location

2200 Northern Blvd Ste 121
East Hills, NY 11548-1220

Mailing address

401 S 8TH St
Lindenhurst, NY 11757-4614
Phone (631) 805-1462

Other practice location 1

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 562-6000

Other practice location 2

260 E 66th St Fl 1
New York, NY 10065-9196
Phone (646) 293-7500

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
I20210304000890 NY Practitioner - Physician Assistant 0547676272 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical Services PCGroup PAC ID 7012016009, 341 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 325-7520

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (516) 705-2689

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022111NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Dec 8, 2021 Accepting new patients
New York University CurrentSince Dec 8, 2021 Accepting new patients
Orthopaedic & Neurosurgery Specialists, PLLC CurrentSince Jan 7, 2026 Accepting new patients
CHS Physician Partners, P.C CurrentSince Mar 1, 2021 Accepting new patients
Orthopaedic & Neurosurgery Specialists, PLLC Physician Assistant CurrentSince Jan 7, 2026 Accepting new patients
Summit Medical Group PA Past Accepting new patients
City Medical of Upper East Side, PLLC Past Accepting new patients

Locations

600 Northern Blvd
Ste 300
Great Neck, NY 11021
Phone (516) 627-8717

2200 Northern Blvd
Ste 121
Greenvale, NY 11548
Phone (516) 705-1044

500 Mamaroneck Ave
Harrison, NY 10528
Phone (203) 869-1145

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

260 E 66th St
Fl 1
New York, NY 10065
Phone (646) 293-7500

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Interoperability endpoints

  • Direct secure messaging: rkelly283388@nyumc.direct-ci.com
  • Direct secure messaging: rkelly69978@northwell.direct-ci.com

Organizations & group practices 9

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 1

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": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1376038695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S 8TH ST",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117574614",
            "telephone_number": "631-805-1462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NORTHERN BLVD STE 121",
            "city": "EAST HILLS",
            "state": "NY",
            "postal_code": "115481220",
            "telephone_number": "516-705-1044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Port Washington Blvd",
            "address_purpose": "LOCATION",
            "city": "Roslyn",
            "state": "NY",
            "postal_code": "115761347",
            "country_code": "US",
            "telephone_number": "516-562-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "260 E 66th St Fl 1",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100659196",
            "country_code": "US",
            "telephone_number": "646-293-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "RAYMOND",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hills, NY

Sources for this page

Verify at the official NPI Registry.