Sarah J Kudelko, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.002330 Issued in OH

Practice address

987 Boardman Canfield Rd
Boardman, OH 44512-4222

Phone

(330) 965-8760

NPI assigned

Jun 25, 2007

Last updated

Apr 3, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optima Dermatology LLCGroup PAC ID 3971561648, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: skudelko@advdermatology.emadirect.md

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.

• Optima Dermatology LLC

  • Dermatology Physician
  • Boardman, OH
  • NPI 1831187764
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Youngstown LLC

  dba Mercy Health St Elizabeth Youngstown Hospital

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  dba Mercy Health Youngstown Laboratory

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238716800000",
    "number": "1508062712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3968 NEW CASTLE RD",
            "address_2": "2",
            "city": "PULASKI",
            "state": "PA",
            "postal_code": "161431231",
            "telephone_number": "724-528-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-965-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDELKO",
        "first_name": "SARAH",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-25",
        "last_updated": "2009-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002330",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052535",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aran Kongmuang, M.D.
• Jennifer Lynn Krasnicki, PHARMD
• Kierra Kruisselbrink
• Kspmd LLC (The Center For Lifestyle Change)
• Bradley Robert Kubis, OD
• Emily Kunselman, OT
• Jacquelyn Marie Kutchel
• Helena Valentina Ladd, PHARMD, RPH, BCPS
• Susan Diana Laird, LPCC-S, CDCA
• Crystal L Lambing, MSN,RN,AGCNS-BC

• Physician Assistant in Boardman, OH
• Providers in Boardman, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.