Individual provider Active NPI

Katelyn Lobnow

  • Medical Physician Assistant
  • Bristol, CT
National Provider Identifier
1609404177
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
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

Updated by the provider on Feb 2, 2021

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 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210219001402 CT Practitioner - Physician Assistant 9739594961 Reassigns benefits to 1 organization

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
Feel Well Health Center of Southington PCGroup PAC ID 8527951870, 5 clinicians

Practice addresses (Care Compare)

710 Main St
BLDG 4
Plantsville, CT 06479-1567
Phone (860) 378-2891

Hospital & facility affiliations

  • Bristol Hospital Hospital, Bristol, CT, CCN 070029
  • The Hospital of Central Connecticut Hospital, New Britain, CT, CCN 070035

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5108CTMDOccupational Therapist
5095-23WIMDPhysician 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.

Hospital & facility affiliations 3

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": "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

Verify at the official NPI Registry.