Active NPI
Kelsey Lynn Lopez, PA-C
- Physician Assistant
- Bronx, NY
National Provider Identifier
1417466228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 021371
- Practice address
- 3424 Kossuth Ave
Bronx, NY 10467-2410 - Phone
- (718) 519-5000
- NPI assigned
- Sep 25, 2017
- 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 | 021371 | NY | Primary |
Addresses
Primary practice location
3424 Kossuth Ave
Bronx, NY 10467-2410
Mailing address
3424 Kossuth Ave
Bronx, NY 10467-2410
Phone (917) 581-3550
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201207002716 | NY | Order and Referring Only - Physician Assistant | 4587076013 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021371 | NY | MD | Physician Assistant |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Interoperability endpoints
- ktaylor234967@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644451200000",
"number": "1417466228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3424 KOSSUTH AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104672410",
"telephone_number": "917-581-3550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3424 KOSSUTH AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104672410",
"telephone_number": "718-519-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "KELSEY",
"middle_name": "LYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-25",
"last_updated": "2022-02-10",
"certification_date": "2022-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "021371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.