Individual provider Active NPI

Kristin L Fitzsimmons, PA

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1679855662
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015106 Issued in NY
Practice address
1415 Portland Ave
Rochester, NY 14621-3038
Phone
(585) 922-4200
Fax
(585) 922-4922
NPI assigned
Sep 15, 2011
Last updated
Sep 22, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015106 NY Primary

Addresses

Primary practice location

1415 Portland Ave
Rochester, NY 14621-3038

Mailing address

1415 Portland Ave
Rochester, NY 14621-3038
Phone (585) 922-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20111005000195 NY Practitioner - Physician Assistant 0941472427 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians

Practice addresses (Care Compare)

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
015106NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Medical Practice P.C. CurrentSince Apr 15, 2017 Accepting new patients
Western New York Medical Practice P.C CurrentSince Apr 15, 2017 Accepting new patients

Locations

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1415 Portland Ave
Rochester, NY 14621
Phone (585) 275-7741

1415 Portland Ave
Ste 400
Rochester, NY 14621
Phone (585) 922-4200

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

Interoperability endpoints

  • Direct secure messaging: kfitzsimmons111419@direct.rochesterregional.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1679855662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-922-4200",
            "fax_number": "585-922-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-922-4200",
            "fax_number": "585-922-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZSIMMONS",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.