NPIMap

Individual provider Active NPI

Kim M O'Brien, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1043539893
Registry record updated May 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
33334681 Issued in NY
Practice address
525 E 68TH St RM 404
New York, NY 10065-4870
Phone
(212) 746-5194
Fax
(212) 746-7868
NPI assigned
May 19, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 33334681 NY Primary

Addresses

Primary practice location

525 E 68TH St RM 404
New York, NY 10065-4870

Mailing address

525 E 68TH St RM 404
New York, NY 10065-4870
Phone (212) 746-5194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180919002350 NY Practitioner - Nurse Practitioner 0345591053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-5162

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
334681NYMDLicensed Practical Nurse
33334681NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Sep 1, 2018 Accepting new patients
Weill Medical College of Cornell CurrentSince Sep 1, 2018 Accepting new patients
Cornell University Medical College Past Accepting new patients

Locations

525 E 68th St
Rm 404
New York, NY 10065
Phone (212) 746-5194

525 E 68th St
Ste M404
New York, NY 10065
Phone (212) 746-5156

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

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.

Hospital & facility affiliations 12

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": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274227200000",
    "number": "1043539893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST RM 404",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5194",
            "fax_number": "212-746-7868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST RM 404",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5194",
            "fax_number": "212-746-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "KIM",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-19",
        "last_updated": "2010-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "33334681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.