Carly Ann Kindbom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA058356 Issued in PA

Practice address

3400 Civic Center Blvd.
East Pavilion, 2ND Floor
Philadelphia, PA 19104-4306

Phone

(215) 615-4949

Fax

(215) 615-0829

NPI assigned

Sep 11, 2015

Sex

Female

Sole proprietor

Yes

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

Enrolled in PA

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• University of Penn - Medical Group

  • Cardiovascular Disease Physician
  • Philadelphia, PA
  • NPI 1093725145
  Medicare reassignment Care Compare group NPD
• Clinical Care Associates of the University of Pennsylvania Health

  • Internal Medicine Physician
  • Radnor, PA
  • NPI 1972682995
  Medicare reassignment
• Clinical Care Associates of the University of Pennsylvania Health

  • Psychologist
  • West Chester, PA
  • NPI 1649940107
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Trustees of the University of Pennsylvania

  dba Hospital of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1609244300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "9 GATES",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-7355",
            "fax_number": "215-349-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD.",
            "address_2": "EAST PAVILION, 2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044306",
            "telephone_number": "215-615-4949",
            "fax_number": "215-615-0829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Cooper Plz",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081031461",
            "country_code": "US",
            "telephone_number": "609-410-7953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINDBOM",
        "first_name": "CARLY",
        "middle_name": "ANN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neal Mulcesh Kinariwala, M.D.
• Amy Patrice Kinateder, RN
• Leigh Erickson Kinczewski, CRNP
• Kind Authentic Therapeutic Initiatives LLC
• Kind Care Homecare LLC
• Kindest Care Healthcare LLC
• Caleb Kindle-Parrish, MD
• Kindness & Kare Transportation
• Kindred Hearts, LLP
• Kindred Home Health Services LLC

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.