Individual provider Active NPI

Kelly Ann Dennin, M.D.

  • Surgery Physician
  • Latham, NY
National Provider Identifier
1760455141
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
199208 Issued in NY
Practice address
6 Wellness Way Ste G12
Latham, NY 12110-2156
Phone
(518) 980-9050
Fax
(518) 980-9051
NPI assigned
Feb 8, 2006
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 199208 NY Primary

Addresses

Primary practice location

6 Wellness Way Ste G12
Latham, NY 12110-2156

Mailing address

6 Wellness Way Ste 201
Latham, NY 12110-2156
Phone (518) 782-3700

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101014000397 NY Practitioner - General Surgery 6204028855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

713 Troy Schenectady Rd
Suite 310
Latham, NY 12110-2490
Phone 51878331103236

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
98.76
Improvement activities
40
Cost
76.76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy47
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
199208NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Surgery CurrentSince Aug 6, 2018 Accepting new patients
Community Care Physicians, PC Surgery PastSince Aug 6, 2018 Accepting new patients

Locations

6 Wellness Way
Ste 201
Latham, NY 12110
Phone (518) 237-7363

6 Wellness Way
Ste G12
Latham, NY 12110
Phone (518) 213-0305

711 Troy Schenectady Rd
Ste 201
Latham, NY 12110

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

713 Troy Schenectady Rd
Ste 310
Latham, NY 12110
Phone 51878331103236

Interoperability endpoints

  • Direct secure messaging: kellydennin@ccp.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1760455141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 WELLNESS WAY STE 201",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102156",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 WELLNESS WAY STE G12",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102156",
            "telephone_number": "518-980-9050",
            "fax_number": "518-980-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIN",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "199208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

Verify at the official NPI Registry.