Individual provider Active NPI

Kyle Sage Deaver, PA

  • Physician Assistant
  • Springfield, MA
National Provider Identifier
1407528789
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2 Medical Center Dr Ste 512
Springfield, MA 01107-1273
Phone
(413) 794-5550
Fax
(413) 794-4212
NPI assigned
Oct 4, 2021
Last updated
May 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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 Primary

Addresses

Primary practice location

2 Medical Center Dr Ste 512
Springfield, MA 01107-1273

Mailing address

280 Chestnut St FL 2
Springfield, MA 01199-1001
Phone (413) 794-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20220415000683 MA Practitioner - Physician Assistant 3779979927 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

280 Chestnut St
Suite 2
Springfield, MA 01199-1001

759 Chestnut St
Springfield, MA 01199-1001
Phone (413) 794-5439

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Women's Health Group, LLC CurrentSince May 8, 2022 Accepting new patients

Locations

2 Medical Center Dr
Ste 512
Springfield, MA 01107
Phone (413) 732-2311

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1407528789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT ST FL 2",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL CENTER DR STE 512",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071273",
            "telephone_number": "413-794-5550",
            "fax_number": "413-794-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAVER",
        "first_name": "KYLE",
        "middle_name": "SAGE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.