Active NPI
Kelly Jo Vollmer, PA
- Physician Assistant
- Colonie, NY
National Provider Identifier
1982894101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 011880
- Practice address
- 105 Everett Rd
Colonie, NY 12205-1407 - Phone
- (518) 694-0999
- Fax
- (518) 694-0998
- NPI assigned
- Jul 25, 2007
- Last updated
- Nov 1, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011880 | NY | Primary |
Addresses
Primary practice location
105 Everett Rd
Colonie, NY 12205-1407
Mailing address
105 Everett Rd
Colonie, NY 12205-1407
Phone (518) 694-0999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03074128 | Medicaid | NY |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
105 Everett Rd
Colonie, NY 12205-1407
Phone (518) 694-0999
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011880 | NY | MD | Speech-Language Pathologist |
Interoperability endpoints
- kellyvollmer@dermpractice.medentdirect.com
Organizations & group practices 1
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.
-
- Dermatopathology Physician
- Colonie, NY
- NPI 1821164096
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Ambulatory Surgical Clinic/Center
- Niskayana, NY
- NPI 1154973071
Hospital
-
- General Acute Care Hospital
- Albany, NY
- NPI 1376577247
-
dba Albany Medical Center South Clinical Campus
- General Acute Care Hospital
- Albany, NY
- NPI 1811917461
-
- General Acute Care Hospital
- Albany, NY
- NPI 1497701106
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509494400000",
"number": "1982894101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 EVERETT RD",
"city": "COLONIE",
"state": "NY",
"postal_code": "122051407",
"telephone_number": "518-694-0999",
"fax_number": "518-694-0998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 EVERETT RD",
"city": "COLONIE",
"state": "NY",
"postal_code": "122051407",
"telephone_number": "518-694-0999",
"fax_number": "518-694-0998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VOLLMER",
"first_name": "KELLY",
"middle_name": "JO",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2017-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011880",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03074128",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colonie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; 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.