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DR. KELLY ANNE LISCIANDRO DO
NPI 1689674814
Internal Medicine in Penfield, NY

Active since July 29, 2005Opted out of Medicare · through Aug 19, 2026
95.19/100
CMS Quality Rating
481 PENBROOKE DRIVE, SUITE 2, PENFIELD, NY 14526(585) 364-0025(585) 364-0024 Get Directions Write a Review

NPPES record last updated: October 16, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kelly Anne Lisciandro Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY ANNE LISCIANDRO DO (NPI 1689674814) is an individual internal medicine provider in Penfield, New York, licensed in New York (228369) and active in the NPI registry since July 2005. She has opted out of Medicare through August 19, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1689674814
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. KELLY ANNE LISCIANDROCredential: DO
Location Address481 PENBROOKE DRIVE, SUITE 2Penfield, NY 14526
Mailing Address481 Penbrooke Drive Ste, Suite 2Penfield, NY 14526 · (585) 364-0025 · Fax (585) 364-0024
Phone(585) 364-0025
Fax(585) 364-0024
Sole ProprietorYes
Enumeration DateJuly 29, 2005
Last NPPES UpdateOctober 16, 2025
NPPES CertifiedOctober 16, 2025
✔ NPI 1689674814 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in NY · 228369✔ Licensed in NY · 228369-1
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
481 PENBROOKE DRIVE, Penfield, NY 14526
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Other Identifiers 4

Other115965BJNY · Preferred Care
Other7441491NY · Aetna
Medicaid02423485NY
OtherP010228369NY · Blue Choice

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kelly Anne Lisciandro Do has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 19, 2024 through August 19, 2026.

Opt-Out Effective DateAugust 19, 2024
Opt-Out In Effect ThroughAugust 19, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14526 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.40 typical visit price
range $54.87 – $166.88
Typical copayment $31.60 (range $13.71 – $41.72)
Most-billed visit code 99204
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality70.62
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each E0955
DME-Wheelchairs · category DD021N
1 supplier17 claims18 services$10.51 avg. paid by Medicare
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory E1028
DME-Wheelchairs · category DD021N
1 supplier16 claims17 services$9.95 avg. paid by Medicare
Manual adult size wheelchair, includes tilt in space E1161
DME-Wheelchairs · category DD000N
1 supplier18 claims18 services$180.26 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Lisciandro's NPI number?

The NPI number for Kelly Lisciandro is 1689674814. It was assigned to this individual provider in the NPPES registry on July 29, 2005.

Where is Kelly Lisciandro located?

Kelly Lisciandro practices at 481 Penbrooke Drive Suite 2, Penfield, NY 14526. The listed phone number is (585) 364-0025.

What is Kelly Lisciandro's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kelly Lisciandro enrolled in Medicare?

No. Kelly Lisciandro has opted out of Medicare through August 19, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Kelly Lisciandro was last updated on October 16, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.