NPIMap

Individual provider Active NPI

Kyle Pane, PA

  • Physician Assistant
  • Brodheadsville, PA
National Provider Identifier
1851874549
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA061510 Issued in PA
Practice address
111 Route 715 Ste 100
Brodheadsville, PA 18322-7101
Phone
(272) 212-0426
Fax
(607) 729-3982
NPI assigned
Sep 10, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022334 NY
Physician Assistant 363A00000X MA061510 PA Primary

Addresses

Primary practice location

111 Route 715 Ste 100
Brodheadsville, PA 18322-7101

Mailing address

111 Route 715 Ste 100
Brodheadsville, PA 18322-7101
Phone (272) 212-0426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20201009000898 PA Practitioner - Physician Assistant 6800148594 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Luke's HospitalGroup PAC ID 0648189688, 100 clinicians
St. Luke's Quakertown HospitalGroup PAC ID 8224010350, 33 clinicians

Practice addresses (Care Compare)

1104 N St
St Luke's Care Now
Jim Thorpe, PA 18229-1717
Phone (570) 325-2400

157 S W End Blvd
Quakertown, PA 18951-1140
Phone (215) 538-4930

2402 Macarthur Rd
Whitehall, PA 18052-3810
Phone (484) 426-2026

2793 Geryville Pike
Pennsburg, PA 18073-2306
Phone (267) 424-8005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022334NYMDPsychologist
MA061510PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Carbon Schuylkill Community Hospital, Inc. CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Quakertown Hospital CurrentSince Aug 3, 2020 Accepting new patients
St Luke's Hospital CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Hospital - Anderson Campus CurrentSince Aug 3, 2020 Accepting new patients
GSL Hospital CurrentSince Jul 19, 2023 Accepting new patients
St. Luke's Hospital Monroe Campus CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Hospital Monroe Campus CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Hosptial CurrentSince Aug 3, 2020 Accepting new patients
The Carbon Schuylkill Community Hospital, Inc. CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Quakertown Hospital CurrentSince Aug 3, 2020 Accepting new patients
St. Luke's Hosptial CurrentSince Aug 3, 2020 Accepting new patients

Locations

111 Route 715
Brodheadsvlle, PA 18322
Phone (272) 212-0420

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

1104 North St
Jim Thorpe, PA 18229
Phone (570) 325-2400

2650 Woodglen Rd
Pottsville, PA 17901
Phone (272) 639-5755

487 E Moorestown Rd
Wind Gap, PA 18091
Phone (484) 526-7850

Interoperability endpoints

  • Direct secure messaging: kyle.pane@slpg.direct-sluhn.org

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

NPI Registry JSON

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1851874549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ROUTE 715 STE 100",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227101",
            "telephone_number": "272-212-0426",
            "fax_number": "607-729-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ROUTE 715 STE 100",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227101",
            "telephone_number": "272-212-0426",
            "fax_number": "607-729-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANE",
        "first_name": "KYLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-10",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022334",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brodheadsville, PA

Sources for this page

Verify at the official NPI Registry.