Active NPI
Katelyn Lobnow
- Medical Physician Assistant
- Bristol, CT
National Provider Identifier
1609404177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 508 Birch St
Bristol, CT 06010-7837 - Phone
- (378) 289-1860
- NPI assigned
- Mar 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5095-23 | WI | |
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
508 Birch St
Bristol, CT 06010-7837
Mailing address
750 Highland Ave
Madison, WI 53705-2221
Other practice location 1
750 Highland Ave
Madison, WI 53705-2221
Phone (608) 263-5620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
710 Main St
BLDG 4
Plantsville, CT 06479-1567
Phone (860) 378-2891
Hospital & facility affiliations
- Bristol Hospital
- The Hospital of Central Connecticut
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5108 | CT | MD | Occupational Therapist |
| 5095-23 | WI | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Plantsville, CT
- NPI 1548305584
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Bristol, CT
- NPI 1619901642
-
- General Acute Care Hospital
- New Britain, CT
- NPI 1548225360
-
- General Acute Care Hospital
- New Britain, CT
- NPI 1053477075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612224000000",
"number": "1609404177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 HIGHLAND AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537052221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 BIRCH ST",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060107837",
"telephone_number": "378-289-1860"
}
],
"practiceLocations": [
{
"address_1": "750 Highland Ave",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537052221",
"country_code": "US",
"telephone_number": "608-263-5620",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LOBNOW",
"first_name": "KATELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-31",
"last_updated": "2021-02-02",
"certification_date": "2021-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "5095-23",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.
- 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.