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COLLEEN KELLY P.A.
NPI 1972755205
Physician Assistant - Surgical in Commack, NY

Active since October 17, 2008PECOS EnrolledAccepts Medicare Assignment
50.12/100
CMS Quality Rating
763 LARKFIELD RD FL 2, COMMACK, NY 11725(631) 462-2225(631) 670-2643 Get Directions Write a Review

NPPES record last updated: October 17, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Colleen Kelly P.a. NPPES

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

COLLEEN KELLY P.A. (NPI 1972755205) is an individual surgical provider in Commack, New York, licensed in Arizona (010544) and active in the NPI registry since October 2008. She is enrolled in Medicare PECOS, is affiliated with Good Samaritan Hospital Medical Center, and is a graduate of New York College Of Podiatric Medicine (2021).

NPPES Registry Identity

NPI1972755205
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameCOLLEEN KELLYCredential: P.A.
Location Address763 LARKFIELD RD FL 2Commack, NY 11725-3131
Mailing Address763 Larkfield Rd Fl 2Commack, NY 11725-3131 · (631) 462-2225 · Fax (631) 670-2643
Phone(631) 462-2225
Fax(631) 670-2643
Sole ProprietorNo
Medical School CMSNew York College Of Podiatric MedicineGraduated 2021
Enumeration DateOctober 17, 2008
✔ NPI 1972755205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in AZ · 010544
763 LARKFIELD RD FL 2, Commack, NY 11725
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Colleen Kelly P.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4284797077
PECOS Enrollment IDI20090105000438
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Good Samaritan Hospital Medical Center

Acute Care Hospitals · West Islip, NY
1/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number330286
Location1000 Montauk HighwayWest Islip, NY 11795 · Suffolk County
Emergency services Birthing friendly

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.

50.12/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality0
Improvement Activities40
Cost67.06

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THOMAS JOSEPH DOWLING III
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)
763 LARKFIELD RD FL 2
COMMACK, NY 11725
Suffolk County (631) 462-2225
MRS. ALEXANDRA MARTE PENALVER
Nurse Practitioner
763 LARKFIELD RD FL 2
COMMACK, NY 11725
Suffolk County (631) 837-2359
MOHAMMED WEISS SANZAR PA-C
Physician Assistant
763 LARKFIELD RD FL 2
COMMACK, NY 11725
Suffolk County (631) 462-2225
ROBERT ANTHONY RISELVATO PA
Physician Assistant (Surgical)
763 LARKFIELD RD FL 2
COMMACK, NY 11725
Suffolk County (631) 462-2225
NEAL H FRAUWIRTH MD
Pain Medicine (Pain Medicine)
763 LARKFIELD RD FL 2
COMMACK, NY 11725
Suffolk County (631) 462-2225

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 Colleen Kelly's NPI number?

The NPI number for Colleen Kelly is 1972755205. It was assigned to this individual provider in the NPPES registry on October 17, 2008.

Where is Colleen Kelly located?

Colleen Kelly practices at 763 Larkfield Rd Fl 2, Commack, NY 11725. The listed phone number is (631) 462-2225.

What is Colleen Kelly's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Colleen Kelly enrolled in Medicare?

Yes. Colleen Kelly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Colleen Kelly affiliated with any hospitals?

According to CMS data, Colleen Kelly is affiliated with Good Samaritan Hospital Medical Center.

When was this NPI record last updated?

The NPPES record for Colleen Kelly was last updated on October 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.