NPIMap

Individual provider Active NPI

Kyle Victor Peterson, PA

  • Physician Assistant
  • New York, NY
National Provider Identifier
1528773397
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
029570 Issued in NY
Practice address
506 Lenox Ave
New York, NY 10037-1802
Phone
(212) 939-1000
NPI assigned
Jan 17, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY
Physician Assistant 363A00000X 029570 NY Primary

Addresses

Primary practice location

506 Lenox Ave
New York, NY 10037-1802

Mailing address

PO Box 210757
Brooklyn, NY 11221-0757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230508002654 NY Practitioner - Physician Assistant 6002271467 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eytan M Debbi MD PCGroup PAC ID 6901310630, 2 clinicians

Practice addresses (Care Compare)

541 E 71St St
FL 6
New York, NY 10021-4871
Phone (212) 606-1408

Hospital & facility affiliations

  • Hospital for Special Surgery Hospital, New York, NY, CCN 330270

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
029570NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ny Society for the Relief of Ruptured & Crippled Maintaining CurrentSince May 20, 2024 Accepting new patients

Locations

541 E 71st St
Fl 6
New York, NY 10021
Phone (201) 599-8056

770 Lexington Ave
New York, NY 10065
Phone (212) 797-8471

541 E 71st St
New York, NY 10021
Phone (212) 606-1136

535 E 70th St
New York, NY 10021

541 E 71st St
#6
New York, NY 10021

541 E 71st St
#4
New York, NY 10021
Phone (212) 774-2837

1133 Westchester Ave
White Plains, NY 10604
Phone (914) 358-9700

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: kpeterson1430773@nychhc.direct-ci.com

Organizations & group practices 3

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 10

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": "1673913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1528773397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 210757",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112210757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KYLE",
        "middle_name": "VICTOR",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-17",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "029570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.