Kaitlin Rose Surber, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

026830 Issued in NY

Practice address

90 Adams PL
Delmar, NY 12054-3224

Phone

(518) 689-2244

Fax

(518) 689-2081

NPI assigned

Jul 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 19, 2021 through Jul 19, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Integrative Medical Associates of New York, PLLC

  • Family Medicine Physician
  • Delmar, NY
  • NPI 1518261163
  NPD

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1497328165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 ADAMS PL",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120543224",
            "telephone_number": "518-689-2244",
            "fax_number": "518-689-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 ADAMS PL",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120543224",
            "telephone_number": "518-689-2244",
            "fax_number": "518-689-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURBER",
        "first_name": "KAITLIN",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan CJ Su, LIA
• Erica Marie Sufrin, PH.D.
• Christi Moot Sulik, RN
• Suresh Sundaram, DDS
• Joseph Sung-Hwan So, DDS
• Susan Gardiner, Psychiatrist,, P.C.
• Timothy David Talmage, DC
• Stephanie Temshiv, LCSW
• Cheryl Tepper
• Erica J Tice, LICENSED ESTHETICIAN

• Physician Assistant in Delmar, NY
• Providers in Delmar, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.