Individual provider Active NPI

Karen L Bertasso, PA

  • Surgical Physician Assistant
  • Albany, NY
National Provider Identifier
1003110412
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
014616 Issued in NY
Practice address
121 Everett Rd
Albany, NY 12205-1474
Phone
(518) 489-2663
NPI assigned
Dec 28, 2010
Last updated
May 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0003582 CO
Surgical Physician Assistant 363AS0400X 014616 NY Primary

Addresses

Primary practice location

121 Everett Rd
Albany, NY 12205-1474

Mailing address

121 Everett Rd
Albany, NY 12205-1474
Phone (518) 489-2663

Other practice location 1

1107 S LeMay Ave
Ste 240
Fort Collins, CO 80524-3960
Phone (970) 495-7421

Other identifiers 1

IdentifierTypeStateIssuer
64429270MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

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
I20110413000337 NY Practitioner - Physician Assistant 6406030600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedicsny, LLPGroup PAC ID 6901898170, 115 clinicians

Practice addresses (Care Compare)

121 Everett Rd
Albany, NY 12205-1474
Phone (518) 489-2663

1768 Route 9
Halfmoon, NY 12065-2402
Phone (518) 489-2663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014616NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedicsny, LLP CurrentSince Jun 1, 2025 Accepting new patients
Orthopedicsny, LLP CurrentSince Jun 1, 2025 Accepting new patients
Executive Woods Ambulatory Surgery Center LLC Past Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients

Locations

123 Everett Rd
Albany, NY 12205
Phone (518) 701-2000

123 Everett Rd
Ste 200
Albany, NY 12205

3 Atrium Dr
Ste 150
Albany, NY 12205
Phone (518) 453-2361

16 Maxwell Dr
Clifton Park, NY 12065
Phone (518) 557-1800

121 Everett Rd
Colonie, NY 12205

250 Delaware Ave
Ste 200
Delmar, NY 12054
Phone (518) 655-1990

1768 Route 9
Halfmoon, NY 12065

Interoperability endpoints

  • Direct secure messaging: kbertasso@orthony.emadirect.md
  • Direct secure messaging: kbertasso788937@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1003110412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051474",
            "telephone_number": "518-489-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 EVERETT RD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051474",
            "telephone_number": "518-489-2663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1107 S LeMay Ave",
            "address_2": "Ste 240",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805243960",
            "country_code": "US",
            "telephone_number": "970-495-7421",
            "fax_number": "970-495-7424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTASSO",
        "first_name": "KAREN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003582",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64429270",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP- Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.