Colleen Kelly, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

010544 Issued in AZ

Practice address

763 Larkfield Rd FL 2
Commack, NY 11725-3131

Phone

(631) 462-2225

Fax

(631) 670-2643

NPI assigned

Oct 17, 2008

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 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

New York College of Podiatric Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Long Island Spine Specialists PCGroup PAC ID 5799676854, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Hospital Medical Center Hospital, West Islip, NY, CCN 330286

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckelly18995@direct-chsli.net

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.

• CHS Physician Partners, PC

  • Interventional Cardiology Physician
  • Fresh Meadows, NY
  • NPI 1407089345
  Medicare reassignment Care Compare group
• Long Island Spine Specialists PC

  • Orthopaedic Surgery of the Spine Physician
  • Commack, NY
  • NPI 1245251198
  Medicare reassignment Care Compare group
• CHS Physician Partners, P.C

  • Cardiovascular Disease Physician
  • Roslyn, NY
  • NPI 1164585725
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Good Samaritan Hospital Medical Center

  • General Acute Care Hospital
  • West Islip, NY
  • NPI 1902865355
  Care Compare affiliation

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224201600000",
    "number": "1972755205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 LARKFIELD RD FL 2",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253131",
            "telephone_number": "631-462-2225",
            "fax_number": "631-670-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 LARKFIELD RD FL 2",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253131",
            "telephone_number": "631-462-2225",
            "fax_number": "631-670-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "COLLEEN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2008-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "010544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marina Kavesteen, M.S. OTR/L
• Patrycja A Kazana, PA-C
• KB Massage Therapy P.C.
• Maria Keating-Padberg, LCSW
• Joanna Keegan
• Dejon Paul Kelly
• Laura Jean Kelly, RD, CSO, CDN
• Maureen Jeanette Kelly, P.A.
• Stephen Patrick Kelly, COTA
• Andrea Michelle Keltos, LMSW

• Surgical Physician Assistant in Commack, NY
• Providers in Commack, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; 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.