Individual provider Active NPI

Kristen Colandrea, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1003467101
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
402842 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(347) 681-4146
NPI assigned
Sep 20, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 402842 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

475 Seaview Ave
Staten Island, NY 10305-3436

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
I20210805002071 NY Practitioner - Nurse Practitioner 0345671947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Professional Medical Concierge Services PLLCGroup PAC ID 0840614020, 75 clinicians

Practice addresses (Care Compare)

1785 Route 9
Halfmoon, NY 12065-2449
Phone (518) 238-6028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Medical Concierge Services, PLLC CurrentSince Jul 19, 2021 Accepting new patients

Locations

1785 Route 9
Halfmoon, NY 12065
Phone (518) 238-6028

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1003467101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "347-681-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLANDREA",
        "first_name": "KRISTEN",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.