NPIMap

Individual provider Active NPI

Kelly J Lupo, PA-C

  • Physician Assistant
  • Ann Arbor, MI
National Provider Identifier
1699982298
Registry record updated Jan 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003533 Issued in MI
Practice address
1500 East Medical Center Dr
2ND Floor Taubman Center Recp 'G'
Ann Arbor, MI 48109-5338
Phone
(734) 936-7010
Fax
(734) 936-9294
NPI assigned
May 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2013

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 5601003533 MI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
2ND Floor Taubman Center Recp 'G'
Ann Arbor, MI 48109-5338

Mailing address

3621 South State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200114000031 NC Practitioner - Physician Assistant 5799751244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Fear Valley Health Medical Group LLCGroup PAC ID 0648707109, 352 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 672-0350

4140 Ferncreek Dr
Suite 801
Fayetteville, NC 28314-2572
Phone (910) 484-2171

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Fear Valley Health Medical Group LLC CurrentSince Mar 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC CurrentSince Mar 15, 2025 Accepting new patients
Cape Fear Valley Health Medical Group LLC Physician Assistant Past Accepting new patients
Island Medical Empire State, PLLC Physician Assistant Past Accepting new patients

Locations

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

1219 Walter Reed Rd
Fayetteville, NC 28304
Phone (910) 609-5000

588 Bailey Rd
Ste K
Lumberton, NC 28358
Phone (910) 615-3550

Interoperability endpoints

  • Direct secure messaging: klupo75803@capefearvalley.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357516800000",
    "number": "1699982298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "2ND FLOOR TAUBMAN CENTER RECP 'G'",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095338",
            "telephone_number": "734-936-7010",
            "fax_number": "734-936-9294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUPO",
        "first_name": "KELLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2013-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.