Kaelyn Elizabeth Cicco, RPA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

014312 Issued in NY

Practice address

5800 Heritage Landing Dr Ste C
East Syracuse, NY 13057-9378

Phone

(314) 445-2701

NPI assigned

Sep 28, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crouse Medical Practice PLLCGroup PAC ID 8426189622, 187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Crouse Medical Practice, PLLC

  • Internal Medicine Physician
  • Syracuse, NY
  • NPI 1922321934

  Medical

  Medicare reassignment Care Compare group NPD
• Pathology Associates of Syracuse, PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Syracuse, NY
  • NPI 1629061791
  NPD

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1902115785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 HERITAGE LANDING DR STE C",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579378",
            "telephone_number": "314-445-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCO",
        "first_name": "KAELYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Miss",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-28",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "014312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcicco@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kcicco@crousemed.medentdirect.com",
            "address_1": "5800 Heritage Landing Dr Ste C",
            "city": "East Syracuse",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130579378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chiropractic First, P.C.
• Diana Christensen, MD
• Amanda Christian, PT, DPT
• Peter J Christiano, M.D.
• David A Churchill, M.D.
• David Cinats
• Jeffrey Cizenski, MD
• Stephanie Anne Clapper, MD
• Clarity Clinical Research, LLC
• Jamison Lee Clark, OTR/L

• Medical Physician Assistant in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.