Active NPI
Kristen Faricellie
- Certified Registered Nurse Anesthetist
- Cleveland, OH
National Provider Identifier
1063136802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0020630
- Practice address
- 9500 Euclid Ave
Cleveland, OH 44195-0001 - Phone
- (216) 444-2200
- NPI assigned
- Sep 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 0020630 | OH | Primary |
Addresses
Primary practice location
9500 Euclid Ave
Cleveland, OH 44195-0001
Mailing address
725 Johnson CT Apt 401
Cleveland, OH 44113-1359
Phone (716) 946-6779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0020630 | OH | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Physicians Surgery Center, LLC | Current | Accepting new patients |
Locations
53990 Carmichael Dr
South Bend, IN 46635
Phone (574) 243-9700
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.
-
- Anesthesiology Physician
- South Bend, IN
- NPI 1669032942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1063136802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 JOHNSON CT APT 401",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441131359",
"telephone_number": "716-946-6779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 EUCLID AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441950001",
"telephone_number": "216-444-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARICELLIE",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "OH",
"license": "0020630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.