Individual provider Active NPI

Kyle Burt Seely, PA-C

  • Physician Assistant
  • Wauwatosa, WI
National Provider Identifier
1811588338
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Phone
(414) 877-5350
NPI assigned
Jan 27, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315

Mailing address

10625 W North Ave Ste 101B
Wauwatosa, WI 53226-2315
Phone (414) 877-5350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, NC, SC3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20220615001136 WI Practitioner - Physician Assistant 4486033891
I20241015000106 NC Practitioner - Physician Assistant 4486033891 Reassigns benefits to 1 organization
I20250130003918 SC Practitioner - Physician Assistant 4486033891 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, shared by 56 NPIs, 2,324 clinicians

Practice addresses (Care Compare)

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-1000

10660 Park Rd
Suite 3100
Charlotte, NC 28210-8420
Phone (704) 667-8750

134 Professional Park Dr
Rock Hill, SC 29732-1178
Phone (704) 667-4045

14214 Ballantyne Lake Rd
Charlotte, NC 28277-3373

1690 Hwy 160 W
Fort Mill, SC 29708-8024
Phone (803) 548-2424

704 Gold Hill Rd
Suite 203
Fort Mill, SC 29715-8907
Phone (803) 835-0405

Hospital & facility affiliations

  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5420SCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Sep 30, 2024 Accepting new patients
EMS Observation, S.C. CurrentSince Jul 3, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 30, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 30, 2024 Accepting new patients
Integrated Therapeutic Massage LLC PastSince Aug 1, 2021 Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

704 Gold Hill Rd
Ste 203
Fort Mill, SC 29715
Phone (803) 835-0405

10625 W North Ave
Ste 101B
Wauwatosa, WI 53226
Phone (414) 727-9183

Interoperability endpoints

  • Direct secure messaging: kseely818239@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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 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": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1811588338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE STE 101B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10625 W NORTH AVE STE 101B",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262315",
            "telephone_number": "414-877-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEELY",
        "first_name": "KYLE",
        "middle_name": "BURT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.