Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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MS. Kelly Ann Groom, MSPA-C

Individual provider Medical Physician Assistant · NPI 1740302421

MS. Kelly Ann Groom, MSPA-C is a Physician Assistant in Bronx, New York. Qualified in 2003, 23 years ago. Practices with North Shore Lij Urgent Care PC, a 395-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
23
Licensed in
NY
In the registry since
2007
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Practice location Address checks out

1803 Mahan Ave
Bronx, NY 10461-4621
Phone: (718) 409-2762
Fax: (718) 863-4432
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 009403 (NY)

Record details

NPI number1740302421
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSPA-C
Sole proprietorNo
NPI enumeratedApril 4, 2007
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice North Shore Lij Urgent Care Pc — 395 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Bronx