Individual provider Active NPI

Kyle Theresa McClintock, CRNA

  • Certified Registered Nurse Anesthetist
  • Portland, ME
National Provider Identifier
1053629857
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
075000 Issued in CT
Practice address
175 Fore River Pkwy
Portland, ME 04102-2779
Phone
(207) 879-3000
NPI assigned
Sep 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN83171 ME
Registered Nurse 163W00000X 075000 CT
Certified Registered Nurse Anesthetist 367500000X 004584 CT
Certified Registered Nurse Anesthetist 367500000X RNA223051 ME
Certified Registered Nurse Anesthetist 367500000X 075000 CT Primary

Addresses

Primary practice location

175 Fore River Pkwy
Portland, ME 04102-2779

Mailing address

29 Mary LN
Cumberland Foreside, ME 04110-1442
Phone (860) 280-5125

Other practice location 1

22 Bramhall St
Portland, ME 04102-3175
Phone (207) 662-0111

Other practice location 2

435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 694-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110311000204 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214119254 Reassigns benefits to 3 organizations
I20221107002926 ME Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214119254 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

155 Rover River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

175 Fore River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

40 Park Rd
Westbrook, ME 04092-3188
Phone (207) 857-8174

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.67 of 100Reported as group
Quality
60.7
Promoting interoperability
91
Improvement activities
40
Cost
73.8

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN83171MEMDRegistered Nurse
004584CTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Regional Medical Center CurrentSince Dec 6, 2023 Accepting new patients
St. Mary'S Regional Medical Center CurrentSince Dec 6, 2023 Accepting new patients
Mercy Hospital CurrentSince Sep 11, 2022 Accepting new patients
Integrated Anesthesia Associates LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2020 Accepting new patients
Wilton Anesthesia Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2019 Accepting new patients
Mercy Hospital Current Accepting new patients
Maine Anesthesia Partners LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 2, 2024 Accepting new patients
Mercy Hospital CurrentSince Sep 11, 2022 Accepting new patients

Locations

4 Northwestern Dr
Bloomfield, CT 06002
Phone (860) 243-2969

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

280 State St
North Haven, CT 06473
Phone (203) 288-2886

2 Corporate Dr
Ste 955
Shelton, CT 06484
Phone (203) 929-7375

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

175 Fore River Pkwy
Portland, ME 04102
Phone (207) 553-6105

53 Sewall St
Portland, ME 04102
Phone (207) 350-5019

405 Western Ave
South Portland, ME 04106
Phone (207) 272-0707

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

400 10th St E
Waconia, MN 55387

Interoperability endpoints

  • Direct secure messaging: kyle.mcclintock@xdr.hhchealthdirect.org

Organizations & group practices 9

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 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": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1053629857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 MARY LN",
            "city": "CUMBERLAND FORESIDE",
            "state": "ME",
            "postal_code": "041101442",
            "telephone_number": "860-280-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 FORE RIVER PKWY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022779",
            "telephone_number": "207-879-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Bramhall St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041023175",
            "country_code": "US",
            "telephone_number": "207-662-0111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "435 Lewis Ave",
            "address_purpose": "LOCATION",
            "city": "Meriden",
            "state": "CT",
            "postal_code": "064512101",
            "country_code": "US",
            "telephone_number": "203-694-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCLINTOCK",
        "first_name": "KYLE",
        "middle_name": "THERESA",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-15",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ME",
            "license": "RN83171",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "075000",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "004584",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "RNA223051",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "075000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.