Active NPI
Kelly Roses
- Physician Assistant
- Staten Island, NY
National Provider Identifier
1962070995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 96 Edgegrove Ave
Staten Island, NY 10312-3312 - Phone
- (718) 696-7717
- NPI assigned
- Jun 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1364201191 | NY | |
| Specialist | 174400000X | |||
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
96 Edgegrove Ave
Staten Island, NY 10312-3312
Mailing address
96 Edgegrove Ave
Staten Island, NY 10312-3312
Phone (718) 696-7717
Other practice location 1
7000 Austin St Ste 200
Forest Hills, NY 11375-4739
Phone (718) 762-7633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
102 James St
Edison, NJ 08820-3970
30 Prospect Ave
Hackensack, NJ 07601-1915
65 James St
Edison, NJ 08820-3947
Phone (732) 321-7901
Hospital & facility affiliations
- JFK University Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.33 of 100
- Quality
- 66.38
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 71.39
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1364201191 | NY | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hackensack Meridian Health Medical Group - Specialty Care PC | Current | Accepting new patients | |
| Hackensack Meridian Health Medical Group - Complex Care PC | Past | Accepting new patients |
Locations
225 May St
Ste A
Edison, NJ 08837
Phone (732) 346-5400
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IHJHBD
Organizations & group practices 4
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.
-
- Surgical Critical Care Physician
- Red Bank, NJ
- NPI 1215989249
-
- Durable Medical Equipment & Medical Supplies
- North Bergen, NJ
- NPI 1215734199
-
- Internal Medicine Physician
- Red Bank, NJ
- NPI 1154379626
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Edison, NJ
- NPI 1144894577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681776000000",
"number": "1962070995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 EDGEGROVE AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123312",
"telephone_number": "718-696-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 EDGEGROVE AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123312",
"telephone_number": "718-696-7717"
}
],
"practiceLocations": [
{
"address_1": "7000 Austin St Ste 200",
"address_purpose": "LOCATION",
"city": "Forest Hills",
"state": "NY",
"postal_code": "113754739",
"country_code": "US",
"telephone_number": "718-762-7633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROSES",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-15",
"last_updated": "2023-04-18",
"certification_date": "2023-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": "1364201191",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.