Jacqueline M Havriliak, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN246320L Issued in PA

Practice address

156 Corliss Ave
Suite 107
Johnson City, NY 13790-2060

Phone

(607) 763-6735

NPI assigned

Jun 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bryn Mawr Medical Specialists AssociationGroup PAC ID 4183610934, 135 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/0d26bd04-9128-4f58-8e6d-ffda5cd00f89/

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.

• Bryn Mawr Medical Specialists Association

  • Multi-Specialty Clinic/Center
  • Bryn Mawr, PA
  • NPI 1841226099
  Medicare reassignment Care Compare group NPD
• Associates in Anesthesia, Inc.

  • Anesthesiology Physician
  • Chadds Ford, PA
  • NPI 1942281191
  Medicare reassignment NPD
• Anesthesia Associates of New London, PC

  • Anesthesiology Physician
  • New London, CT
  • NPI 1205881117
  NPD (past)
• Anesthesia Services PA

  • Anesthesiology Physician
  • New Castle, DE
  • NPI 1053366377
  NPD (past)
• Associates in Anesthesia

  • Anesthesiology Physician
  • Chadds Ford, PA
  • NPI 1336470467
  NPD (past)
• Mercy Tyler Health Systems

  • Surgery Physician
  • Tunkhannock, PA
  • NPI 1881616985
  NPD (past)
• Mercy Tyler Hospital

  • General Acute Care Hospital
  • Tunkhannock, PA
  • NPI 1386667533
  NPD (past)
• Waterbury Anesthesiology Assoc. Inc

  • Anesthesiology Physician
  • Waterbury, CT
  • NPI 1780631960
  NPD (past)

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063457760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 CORLISS AVE",
            "address_2": "SUITE 107",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902060",
            "telephone_number": "607-763-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 CORLISS AVE",
            "address_2": "SUITE 107",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902060",
            "telephone_number": "607-763-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVRILIAK",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN246320L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Lee Hastings Jr., DO
• Hatala Orthodontics PC
• Mark P Hatala, DDS
• Raven Hathaway, FNP-BC
• Samantha Grace Hathaway, DO
• Amy Marie Hawley, NP
• Hayfa Hazar, CRNA
• Megan Hazelton, MS
• HCA
• Brian Hebbard

• Certified Registered Nurse Anesthetist in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.