Nicole K Kelly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

014253 Issued in NY

Practice address

30 Hatfield LN
Ste 109
Goshen, NY 10924-6766

Phone

(845) 692-3111

Fax

(845) 294-0118

NPI assigned

Jan 24, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Nicole K Falco Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989

Interoperability endpoints

• Direct secure messaging: nicole.kelly@hfmg.eclinicaldirectplus.com

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.

• Horizon Medical Group, P.C.

  • Family Medicine Physician
  • Goshen, NY
  • NPI 1063488179
  Medicare reassignment
• Horizon Medical Group, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Yorktown Heights, NY
  • NPI 1386520021
  NPD

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1760787709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 COATES DR",
            "city": "GOSHEN",
            "state": "NY",
            "postal_code": "109246758",
            "telephone_number": "845-651-1412",
            "fax_number": "845-651-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HATFIELD LN",
            "address_2": "STE 109",
            "city": "GOSHEN",
            "state": "NY",
            "postal_code": "109246766",
            "telephone_number": "845-692-3111",
            "fax_number": "845-294-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICOLE",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "1095483",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "FALCO",
            "middle_name": "K",
            "prefix": "MISS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jyothi S. Kavuri, D.D.S
• Hratch Kazanjian, M.D.
• Laura Beth Keller
• Linda S Keller, FNP
• Flynn M Kelly
• Laura Price Kennedy, PSY.D.
• Katherine Grady Kennett, RN
• Karlene H Kerr, RN
• Javed I Khokhar, RPH
• Kids Play Occupational Therapy, PLLC

• Physician Assistant in Goshen, NY
• Providers in Goshen, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.