Individual provider Active NPI

Julie L Kellerman, R.P.A.-C

  • Physician Assistant
  • Niagara Falls, NY
National Provider Identifier
1467505735
Registry record updated Mar 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011469-1 Issued in NY
Practice address
6934 Elaine Dr
Niagara Falls, NY 14304-2876
Phone
(716) 297-7898
NPI assigned
Jan 19, 2007
Last updated
Mar 8, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2016

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 011469-1 NY Primary

Addresses

Primary practice location

6934 Elaine Dr
Niagara Falls, NY 14304-2876

Mailing address

2 Cherokee Dr
West Seneca, NY 14224-4736
Phone (716) 908-9688

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070827000846 NY Practitioner - Physician Assistant 0840382487 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jayaselvi Kolli MD PCGroup PAC ID 1456367853, 2 clinicians

Practice addresses (Care Compare)

6934 Elaine Dr
Niagara Falls, NY 14304-2876
Phone (716) 298-7898

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
011469-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Academic Medicine Services, Inc. Past Accepting new patients
Lisa S. Ball, Family Health NP, PLLC PastSince Oct 12, 2017 Accepting new patients
Joseph B. Neiman, MD, PC PastSince May 20, 2002 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1467505735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CHEROKEE DR",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142244736",
            "telephone_number": "716-908-9688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6934 ELAINE DR",
            "city": "NIAGARA FALLS",
            "state": "NY",
            "postal_code": "143042876",
            "telephone_number": "716-297-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERMAN",
        "first_name": "JULIE",
        "middle_name": "L",
        "credential": "R.P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011469-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niagara Falls, NY

Sources for this page

Verify at the official NPI Registry.