Individual provider Active NPI

Kyle Lewis, M.D.

  • Emergency Medicine Physician
  • State College, PA
National Provider Identifier
1871911610
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD460713 Issued in PA
Practice address
1800 East Park Ave
State College, PA 16803-1501
Phone
(814) 231-7000
NPI assigned
Mar 30, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD460713 PA Primary

Addresses

Primary practice location

1800 East Park Ave
State College, PA 16803-1501

Mailing address

1800 East Park Avenue Attn Cema
State College, PA 16803
Phone (814) 231-7000

Other practice location 1

6411 Fannin St
Houston, TX 77030-1501
Phone (713) 704-4060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170808003053 PA Practitioner - Emergency Medicine 1759652852 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD460713PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centre Emergency Medical Associates, PC. Emergency Medicine CurrentSince Aug 1, 2017 Accepting new patients

Locations

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1396137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1871911610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 EAST PARK AVENUE ATTN CEMA",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "16803",
            "telephone_number": "814-231-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 EAST PARK AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168031501",
            "telephone_number": "814-231-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6411 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301501",
            "country_code": "US",
            "telephone_number": "713-704-4060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KYLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD460713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.