Kerry Kunrong Nie, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

50002031 Issued in OH

Practice address

30 E Apple St
Ste 1480
Dayton, OH 45409-2939

Phone

(937) 208-3220

Fax

(937) 208-3633

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Dr Yang Integrated Medicine PC

  • Medical Specialty Clinic/Center
  • Flushing, NY
  • NPI 1306223441
  Medicare reassignment

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1780770057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST",
            "address_2": "STE 1480",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-3220",
            "fax_number": "937-208-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E APPLE ST",
            "address_2": "STE 1480",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092939",
            "telephone_number": "937-208-3220",
            "fax_number": "937-208-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIE",
        "first_name": "KERRY",
        "middle_name": "KUNRONG",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50002031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110876",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melynda Nickles, LSW
• Lynn Anastasia Nickol, RD
• Paige Nickol, LSW
• Chelsea Ann Nickolson, D.O., M.B.A.
• Ann Marie Nie, RN, CNP, APRN
• Marjorie A. Niederkohr, R.PH.
• Mark Niederkohr, RPH
• Lora Ann Niekamp
• Mary Jane Nielsen, MSSA, LISW
• Raven Leigh Nielsen, LMT

• Surgical Physician Assistant in Dayton, OH
• Providers in Dayton, OH by specialty
• Surgical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.