Individual provider Active NPI

Kyle Swain

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1609521475
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
61661 Issued in CA
Practice address
1419 Salt Springs Rd
Syracuse, NY 13214-1301
Phone
(315) 445-4100
NPI assigned
Feb 19, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 61661 CA Primary

Addresses

Primary practice location

1419 Salt Springs Rd
Syracuse, NY 13214-1301

Mailing address

1419 Salt Springs Rd
Syracuse, NY 13214-1301
Phone (315) 445-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20221103002728 CA Practitioner - Physician Assistant 2961879952 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61661CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Nov 1, 2022 Accepting new patients
Cep America-California CurrentSince Nov 1, 2022 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

Interoperability endpoints

  • Direct secure messaging: kswain575781@direct.llu.edu

Organizations & group practices 4

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": "1645228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1609521475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 SALT SPRINGS RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141301",
            "telephone_number": "315-445-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 SALT SPRINGS RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141301",
            "telephone_number": "315-445-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWAIN",
        "first_name": "KYLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-19",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "61661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.