NPIMap

Individual provider Active NPI

Kellianne Tulley

  • Physician Assistant
  • Merrick, NY
National Provider Identifier
1760842637
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
19479 Issued in NY
Practice address
21 Woodbine Ave
Merrick, NY 11566-3130
Phone
(516) 663-8963
NPI assigned
Mar 4, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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 19479 NY Primary

Addresses

Primary practice location

21 Woodbine Ave
Merrick, NY 11566-3130

Mailing address

21 Woodbine Ave
Merrick, NY 11566-3130

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ktulley311357@nyumc.direct-ci.com Other NYU Langone

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20170202001147 NY Practitioner - Physician Assistant 3678856457 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019470NYMDCounseling Psychologist
19479NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Hospital United States Catholic Conference CurrentSince Feb 24, 2019 Accepting new patients
New York University CurrentSince Jul 8, 2019 Accepting new patients
Mercy Medical Center CurrentSince Oct 1, 2017 Accepting new patients
New York University CurrentSince Jul 8, 2019 Accepting new patients
Mercy Medical Center CurrentSince Oct 1, 2017 Accepting new patients
Good Samaritan Hospital Medical CurrentSince Dec 24, 2016 Accepting new patients
St. Francis Hospital CurrentSince Feb 24, 2019 Accepting new patients

Locations

4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250

200 Old Country Rd
Mineola, NY 11501
Phone (516) 408-4900

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 7

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": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1760842637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 WOODBINE AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115663130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 WOODBINE AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115663130",
            "telephone_number": "516-663-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLEY",
        "first_name": "KELLIANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-04",
        "last_updated": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "19479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ktulley311357@nyumc.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "NYU Langone",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "address_1": "21 Woodbine Ave",
            "city": "Merrick",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115663130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Merrick, NY

Sources for this page

Verify at the official NPI Registry.