Individual provider Active NPI

Kelly Senour, PA-C

  • Surgical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1508686205
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA066023 Issued in PA
Practice address
3400 Spruce Street
3 Silverstein BLDG
Philadelphia, PA 19104-4206
Phone
(215) 662-3487
NPI assigned
Oct 16, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 25MP00890500 NJ
Surgical Physician Assistant 363AS0400X MA066023 PA Primary

Addresses

Primary practice location

3400 Spruce Street
3 Silverstein BLDG
Philadelphia, PA 19104-4206

Mailing address

3400 Spruce Street
3 Silverstein BLDG
Philadelphia, PA 19104-4206

Other practice location 1

3400 Civic Center Blvd
Philadelphia, PA 19104-5127
Phone (609) 832-5060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 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
I20241107001233 PA Practitioner - Physician Assistant 9335673714 Reassigns benefits to 1 organization
I20250324000091 NJ Practitioner - Physician Assistant 9335673714 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00890500NJMDSurgical Physician Assistant
MA066023PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Nov 18, 2024 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jan 17, 2025 Accepting new patients
University of Penn-Medical Group CurrentSince Nov 18, 2024 Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Jan 17, 2025 Accepting new patients

Locations

1600 Haddon Ave
Camden, NJ 08103
Phone (609) 757-3500

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

3400 Spruce St
Fl 3
Philadelphia, PA 19104

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1508686205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 SILVERSTEIN BLDG",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "3 SILVERSTEIN BLDG",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Civic Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191045127",
            "country_code": "US",
            "telephone_number": "609-832-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SENOUR",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00890500",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA066023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.