Kaitlin Connelly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00298300 Issued in NJ

Practice address

352 S Delsea Dr Unit C
Vineland, NJ 08360-5308

Phone

(856) 690-1616

Fax

(856) 896-6107

NPI assigned

Dec 5, 2012

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

Medicare fee-for-service enrollment

Enrolled in NJ

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, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLCGroup PAC ID 1557388436, 36 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

54.35 of 100Reported as group

Quality

27.28

Promoting interoperability

0

Improvement activities

40

Cost

80.29

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.

• Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Vineland, NJ
  • NPI 1396812574
  Medicare reassignment Care Compare group
• Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Mullica Hill, NJ
  • NPI 1457092611
  NPD

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1952646747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 S DELSEA DR UNIT C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605308",
            "telephone_number": "856-690-1616",
            "fax_number": "856-896-6107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 S DELSEA DR UNIT C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605308",
            "telephone_number": "856-690-1616",
            "fax_number": "856-896-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "KAITLIN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-05",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00298300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Comunidad Unida Para la Rehabilitacion de Adictos
• Comunidad Unida Para Rehabilitacion de Adictos
• Confident Care Corp
• Emilia Conlan
• Elizabeth Connelly
• Theodore Alexander Conover, MD
• Deirdre M Conroy, APN
• Lady Renee Bassig Consolacion
• Staci Cook-White, M.S.W., L.C.S.W.
• Don S Cooper, DC

• Medical Physician Assistant in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.