Individual provider Active NPI

Katrina Elise Davis, PA-C

  • Physician Assistant
  • Forest Hills, NY
National Provider Identifier
1457993362
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
024230 Issued in NY
Practice address
102-01 66TH Rd
Forest Hills, NY 11375
Phone
(718) 830-4000
NPI assigned
Oct 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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 024230 NY Primary

Addresses

Primary practice location

102-01 66TH Rd
Forest Hills, NY 11375

Mailing address

102-01 66TH Rd
Forest Hills, NY 11375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 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
I20200803000093 NY Practitioner - Physician Assistant 5890110290 Reassigns benefits to 1 organization
I20230711003885 TX Practitioner - Physician Assistant 5890110290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2201 Inwood Rd
Dallas, TX 75235-7320
Phone (214) 645-2700

6201 Harry Hines Blvd
Dallas, TX 75235-5202
Phone (817) 987-3955

6202 Harry Hines Blvd
Dallas, TX 75235-5202
Phone (469) 488-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024230NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jun 12, 2023 Accepting new patients
North Shore - Lij Medical PC CurrentSince May 19, 2021 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jun 12, 2023 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

972 Brush Hollow Rd
Westbury, NY 11590

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 5

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": "1570752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1457993362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102-01 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "11375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102-01 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "11375",
            "telephone_number": "718-830-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KATRINA",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.