Active NPI
Kelly S. Mickulik, PA-C
- Physician Assistant
- Reading, PA
National Provider Identifier
1386643880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA050888
- Practice address
- 3317 Penn Ave
Reading, PA 19609-1436 - Phone
- (610) 750-7891
- Fax
- (610) 750-7894
- NPI assigned
- Jul 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA050888 | PA | Primary |
Addresses
Primary practice location
3317 Penn Ave
Reading, PA 19609-1436
Mailing address
3317 Penn Ave
Reading, PA 19609-1436
Phone (610) 750-7891
Other practice location 1
2210 Ridgewood Rd
Ste 100
Wyomissing, PA 19610-1167
Phone (610) 372-0502
Other practice location 2
2210 Ridgewood Rd
Ste 100
Wyomissing, PA 19610-1167
Phone (610) 372-0502
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3317 Penn Ave
West Lawn, PA 19609-1436
Phone (610) 644-8225
Hospital & facility affiliations
- Reading Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.97 of 100
- Quality
- 94.86
- Promoting interoperability
- 95
- Improvement activities
- 40
- Cost
- 79.21
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Dermatology Physician
- West Lawn, PA
- NPI 1942442553
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- West Reading, PA
- NPI 1467007112
-
- General Acute Care Hospital
- West Reading, PA
- NPI 1669530069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535500800000",
"number": "1386643880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3317 PENN AVE",
"city": "READING",
"state": "PA",
"postal_code": "196091436",
"telephone_number": "610-750-7891",
"fax_number": "610-750-7894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3317 PENN AVE",
"city": "READING",
"state": "PA",
"postal_code": "196091436",
"telephone_number": "610-750-7891",
"fax_number": "610-750-7894"
}
],
"practiceLocations": [
{
"address_1": "2210 Ridgewood Rd",
"address_2": "Ste 100",
"address_purpose": "LOCATION",
"city": "Wyomissing",
"state": "PA",
"postal_code": "196101167",
"country_code": "US",
"telephone_number": "610-372-0502",
"fax_number": "610-372-9554",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2210 Ridgewood Rd",
"address_2": "Ste 100",
"address_purpose": "LOCATION",
"city": "Wyomissing",
"state": "PA",
"postal_code": "196101167",
"country_code": "US",
"telephone_number": "610-372-0502",
"fax_number": "610-372-9554",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MICKULIK",
"first_name": "KELLY",
"middle_name": "S.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-18",
"last_updated": "2018-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA050888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reading, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.