Kevin A Lane Sr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005639 Issued in NY

Practice address

622 W 168TH St # VC-260
New York, NY 10032-3720

Phone

(212) 305-6059

Fax

(347) 479-1303

NPI assigned

Aug 19, 2006

Last updated

Jan 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in NY, GA, OH, NJ, PA, WV6 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 6

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: qcm9007@direct.nyp.org

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.

• Trustees of Columbia University in the City of New York

  • Surgery Physician
  • New York, NY
  • NPI 1508266347
  Medicare reassignment NPD
• Heritage Medical House Call

  • Home Health Agency
  • Stone Mountain, GA
  • NPI 1063778983
  NPD Authorized official
• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment
• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855
  Medicare reassignment
• Dobbs Ferry Emergency Medicine, PC

  • Emergency Medicine Physician
  • Dobbs Ferry, NY
  • NPI 1457381477
  Medicare reassignment
• Essen Medical Urgicare, PLLC

  dba Metro Urgicare

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1841607298
  Medicare reassignment
• House Call Medical Services of New York, PLLC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1851345946
  Medicare reassignment
• Optum Urgent Care, PLLC

  • Urgent Care Clinic/Center
  • Jericho, NY
  • NPI 1285975797
  Medicare reassignment
• Fairview Hospital

  • Obstetrics & Gynecology Physician
  • Cleveland, OH
  • NPI 1407953706
  Medicare reassignment
• Greenbrier Emergency Services, Inc.

  • Emergency Medicine Physician
  • Gassaway, WV
  • NPI 1568401461
  Medicare reassignment
• Infocus Urgent Care Campus Town, LLC

  • Urgent Care Clinic/Center
  • Ewing, NJ
  • NPI 1376089979
  Medicare reassignment
• Mahoning Valley Emergency Specialists LLC

  • Emergency Medicine Physician
  • Youngstown, OH
  • NPI 1003869652
  Medicare reassignment

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1821102203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST # VC-260",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-6059",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST # VC-260",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-6059",
            "fax_number": "347-479-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "KEVIN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002999",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0003531",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2978",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005639",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "005639",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St # Vc-260",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St # Vc-260",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "qcm9007@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "622 W 168th St # Vc-260",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Frederick Alan Lane, DDS
• Jane F Lane, LCSW
• Jesse Lane, LMSW
• Joseph M Lane, M.D.
• Kentaysha Anita Lane
• Laura Anne Lane, NNP-BC
• Marilyn Lane
• Olivia Lane, LCSW
• Sarah Lane
• Tama Lane

• Physician Assistant in New York, NY
• Providers in New York, 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 Jan 28, 2025; 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.