Individual provider Active NPI

Kelly Marie Rausch, PNP

  • Pediatric Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1982703674
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F381753 Issued in NY
Practice address
1021 Broadway St
Buffalo, NY 14212-1460
Phone
(716) 852-1578
Fax
(716) 852-5154
NPI assigned
Sep 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 441200 NY
Pediatric Nurse Practitioner 363LP0200X F381753 NY Primary

Addresses

Primary practice location

1021 Broadway St
Buffalo, NY 14212-1460

Mailing address

1001 Main St FL 5
Buffalo, NY 14203-1009
Phone (716) 323-0034

Other identifiers 6

IdentifierTypeStateIssuer
00027206901OtherNYUNIVERA
9512852OtherNYIHA
02665525MedicaidNY
080407000087OtherNYFIDELIS
000560953001OtherNYBC/BS
050816000026OtherNYFIDELIS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060221000306 NY Practitioner - Nurse Practitioner 9032146592 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
441200NYMDRegistered Nurse
F381753NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleida Health Current Accepting new patients
University at Buffalo Pathologists, Inc Current Accepting new patients
Kaleida Health CurrentSince Nov 4, 2017 Accepting new patients
Kaleida Health CurrentSince Nov 4, 2017 Accepting new patients
University at Buffalo Pediatric Associates Inc CurrentSince Apr 15, 2020 Accepting new patients

Locations

1404 Sweet Home Rd
Ste 56
Buffalo, NY 14228
Phone (716) 639-9361

1021 Broadway St
Buffalo, NY 14212
Phone (716) 529-3020

1404 Sweet Home Rd
Buffalo, NY 14228
Phone (716) 932-6060

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

1001 Main St
Fl 5
Buffalo, NY 14203
Phone (716) 323-0031

219 Bryant St
Buffalo, NY 14222
Phone (716) 878-7000

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1982703674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST FL 5",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031009",
            "telephone_number": "716-323-0034",
            "fax_number": "716-323-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BROADWAY ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142121460",
            "telephone_number": "716-852-1578",
            "fax_number": "716-852-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAUSCH",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "441200",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F381753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00027206901",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "9512852",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02665525",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "080407000087",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000560953001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "050816000026",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.