Kim Ellen Walecka I, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

216893 Issued in MA

Practice address

228 Old Westport Rd
Dartmouth, MA 02747-2353

Phone

(774) 202-5729

NPI assigned

Dec 19, 2005

Last updated

Oct 12, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kim Ellen Derossi Former name

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Lifespan Physician Group of Massachusetts IncGroup PAC ID 3870020399, 458 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Anne's Hospital Hospital, Fall River, MA, CCN 220020

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwalecka236223@brownhealth.medalliesdirect.net

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.

• Lifespan Physician Group of Massachusetts Inc

  dba Brown Health Medical Group

  • Family Medicine Physician
  • Taunton, MA
  • NPI 1235957713
  Medicare reassignment Care Compare group NPD
• Anesthesia Professionals, Inc.

  • Certified Registered Nurse Anesthetist
  • Dartmouth, MA
  • NPI 1659346443

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Steward Medical Group, Inc

  • Anesthesiology Physician
  • Fall River, MA
  • NPI 1043711914

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Steward Medical Group, Inc

  • Specialist
  • Watertown, MA
  • NPI 1629398219
  Medicare reassignment NPD
• Narragansett Bay Anesthesia, LLC

  • Anesthesiology Physician
  • Warwick, RI
  • NPI 1861445728

  MA

  Medicare reassignment
• Lifespan Corporation

  • Children's Rehabilitation Hospital
  • Providence, RI
  • NPI 1790221232
  NPD
• Caritas Medical Group, Inc.

  • Specialist
  • Brighton, MA
  • NPI 1174513204
  NPD (past)
• Falmouth Anesthesia and Pain Management PC

  • Anesthesiology Physician
  • North Falmouth, MA
  • NPI 1386894426
  NPD (past)
• Heritage Medical Group Inc.

  • Anesthesiology Physician
  • Sandwich, MA
  • NPI 1902853468
  NPD (past)
• MVP Anesthesia Associates, PC

  • Anesthesiology Physician
  • Norwood, MA
  • NPI 1477507598

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

• Lifespan of Massachusetts - Fall River Inc

  • General Acute Care Hospital
  • Fall River, MA
  • NPI 1972330165
  Care Compare affiliation

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1053397414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 OLD WESTPORT RD",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "027472353",
            "telephone_number": "774-202-5729",
            "fax_number": "508-648-1571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 OLD WESTPORT RD",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "027472353",
            "telephone_number": "774-202-5729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALECKA",
        "first_name": "KIM",
        "middle_name": "ELLEN",
        "name_suffix": "I",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-19",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "216893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "DEROSSI",
            "middle_name": "ELLEN",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert Vincelette, RPH
• Maria Viveiros, LMHC
• Susan E Vogler, D.O.
• Denise A Walbridge, ANP
• Claire S Walecka, NP
• Angila M Walker
• Paula Walsh, NP
• Vydalize Warenycia
• Emily Katherine Weibel, NP
• Benjamin Ari Weistrop, MD

• Certified Registered Nurse Anesthetist in Dartmouth, MA
• Providers in Dartmouth, MA by specialty
• Certified Registered Nurse Anesthetist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.