Individual provider Active NPI

Robert J. Melanson, PA-C

  • Physician Assistant
  • Kingston, NY
National Provider Identifier
1386674653
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0066681 Issued in NY
Practice address
396 Broadway
Kingston, NY 12401-4626
Phone
(845) 334-2890
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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 0066681 NY Primary

Addresses

Primary practice location

396 Broadway
Kingston, NY 12401-4626

Mailing address

PO Box 10730
Westminster, CA 92685-0730
Phone (562) 809-3548

Other identifiers 1

IdentifierTypeStateIssuer
02004451MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NM2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040803000340 NY Practitioner - Physician Assistant 5496726648 Reassigns benefits to 2 organizations
I20120126000520 NM Practitioner - Physician Assistant 5496726648 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
48.64 of 100Reported as group
Quality
9.4
Improvement activities
40
Cost
82.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006668NYMDAcupuncturist
0066681NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nes Arizona Inc CurrentSince Jul 1, 2023 Accepting new patients
Eos Medical Group PC Past Accepting new patients
Atlantic Physician Services of Maryland, PC Physician Assistant Past Accepting new patients
Island Medical Empire State, PLLC Physician Assistant Past Accepting new patients

Locations

2430 W Pierce St
Carlsbad, NM 88220
Phone (505) 887-4100

4311 E Lohman Ave
Las Cruces, NM 88011
Phone (505) 556-6800

405 W Country Club Rd
Roswell, NM 88201
Phone (505) 622-8170

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.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1386674653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10730",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926850730",
            "telephone_number": "562-809-3548",
            "fax_number": "562-468-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 BROADWAY",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124014626",
            "telephone_number": "845-334-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELANSON",
        "first_name": "ROBERT",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "0066681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02004451",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

Verify at the official NPI Registry.