Individual provider Active NPI

Kateland Heidi Kelly, PA-C

  • Physician Assistant
  • New Milford, CT
National Provider Identifier
1700178191
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5214 Issued in CT
Practice address
11 Old Park Lane Rd
New Milford, CT 06776-2507
Phone
(860) 355-1149
Fax
(860) 210-2008
NPI assigned
May 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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 055.0031323 VT
Physician Assistant 363A00000X 5214 CT Primary

Addresses

Primary practice location

11 Old Park Lane Rd
New Milford, CT 06776-2507

Mailing address

11 Old Park Lane Rd
New Milford, CT 06776-2507
Phone (860) 355-1149

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
I20210927001135 CT Practitioner - Physician Assistant 7214109875 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New Milford Medical Group, LLCGroup PAC ID 3678469384, 10 clinicians

Practice addresses (Care Compare)

11 Old Park Lane
New Milford, CT 06776-2507

11 Old Park Lane Rd
New Milford, CT 06776-2507
Phone (860) 355-1149

Hospital & facility affiliations

  • Western Connecticut Home Care Inc Home health agency, Danbury, CT, CCN 077088
  • Danbury Hospital Hospital, Danbury, CT, CCN 070033

Merit-based Incentive Payment System (MIPS)

Final score
46.05 of 100Reported as group
Quality
10.81
Promoting interoperability
77
Improvement activities
0
Cost
76.57

Merit-based Incentive Payment System (MIPS)

Final score
77.63 of 100Reported as group
Quality
62.23
Improvement activities
40
Cost
81.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5214CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Neighborhood Health Services PastSince Oct 1, 2021 Accepting new patients
Clearchoicemd Primary Care PLLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kateland.kelly.p1@direct.nmmg.nextgenshare.com

Organizations & group practices 3

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": "1304467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1700178191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 OLD PARK LANE RD",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762507",
            "telephone_number": "860-355-1149",
            "fax_number": "860-210-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 OLD PARK LANE RD",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762507",
            "telephone_number": "860-355-1149",
            "fax_number": "860-210-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KATELAND",
        "middle_name": "HEIDI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-04",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031323",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Milford, CT

Sources for this page

Verify at the official NPI Registry.