Kieran Donnelly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

026996 Issued in NY

Practice address

327 Beach 19TH St
Far Rockaway, NY 11691-4423

Phone

(718) 869-7000

NPI assigned

Dec 19, 2019

Last updated

Aug 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Medical Wellness PCGroup PAC ID 6709128697, 22 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.85 of 100Reported as group

Quality

79.23

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Community Medical Wellness PC

  • Pain Medicine Physician
  • Port Jefferson Station, NY
  • NPI 1073002473
  Medicare reassignment Care Compare group
• Island Emergency Medical Services, P.C.

  • Emergency Medicine Physician
  • Far Rockaway, NY
  • NPI 1639160385
  Medicare reassignment

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1922646066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 BEACH 19TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914423",
            "telephone_number": "631-848-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 BEACH 19TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914423",
            "telephone_number": "718-869-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37 Trask Ln",
            "address_purpose": "LOCATION",
            "city": "Babylon",
            "state": "NY",
            "postal_code": "117024006",
            "country_code": "US",
            "telephone_number": "631-848-4181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "KIERAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-19",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marsha Dillon White, RN, NP
• Daniel Posner Dinardo, D.O.
• Gayanthi Dissanayake, MD
• Leigh Anne Ditchek
• Sarrah Dominique, MD
• Yocheved Rochel Donowitz, M.S
• Ludentz Dorcelus
• Waveney Virginia Douglas, LPN
• Belma Doyle, D.O
• Dr Lloyd Bardfeld

• Physician Assistant in Far Rockaway, NY
• Providers in Far Rockaway, 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 Aug 18, 2021; 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.