Individual provider Active NPI

Andromeda Raindance

  • Family Nurse Practitioner
  • Kingston, NY
National Provider Identifier
1033557640
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
355983 Issued in NY
Practice address
360 Washington Ave
Kingston, NY 12401-3702
Phone
(845) 338-7140
NPI assigned
Jun 6, 2013
Last updated
Jul 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 283728 NY
Family Nurse Practitioner 363LF0000X 355983 NY Primary

Addresses

Primary practice location

360 Washington Ave
Kingston, NY 12401-3702

Mailing address

105 Cottontail Lane
Woodstock, NY 12498
Phone (845) 332-7884

Other practice location 1

105 Cottontail Lane
Woodstock, NY 12498
Phone (845) 332-7884

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
I20250813000547 NY Practitioner - Nurse Practitioner 8022516533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Associates of the Hudson ValleyGroup PAC ID 2860384674, 24 clinicians

Practice addresses (Care Compare)

360 Washington Ave
Kingston, NY 12401-3702
Phone (845) 338-7140

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
283728NYMDLicensed Practical Nurse
355983NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of the Hudson Valley CurrentSince Aug 1, 2025 Accepting new patients
Medical Associates of the Hudson Valley PastSince Mar 12, 2024 Accepting new patients

Locations

360 Washington Ave
Kingston, NY 12401
Phone (845) 338-7140

9 Elwyn Ln
Woodstock, NY 12498
Phone (845) 338-7140

Interoperability endpoints

  • Direct secure messaging: araindance@mahv.medentdirect.com

Organizations & group practices 2

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 4

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": "1370476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1033557640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 COTTONTAIL LANE",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "12498",
            "telephone_number": "845-332-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 WASHINGTON AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013702",
            "telephone_number": "845-338-7140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Cottontail Lane",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "NY",
            "postal_code": "12498",
            "country_code": "US",
            "telephone_number": "845-332-7884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAINDANCE",
        "first_name": "ANDROMEDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-06",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "283728",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "355983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

Verify at the official NPI Registry.