Individual provider Active NPI

Krista Lynn Wasserman, MD

  • Obstetrics & Gynecology Physician
  • Woodbury, NY
National Provider Identifier
1063806552
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
299420 Issued in NY
Practice address
40 Crossways Park Dr Ste 101
Woodbury, NY 11797-2038
Phone
(516) 496-3900
NPI assigned
Mar 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 299420 NY
Obstetrics Physician 207VX0000X 299420 NY
Obstetrics & Gynecology Physician 207V00000X 299420 NY Primary

Addresses

Primary practice location

40 Crossways Park Dr Ste 101
Woodbury, NY 11797-2038

Mailing address

900 Merchants Concourse Ste 216
Westbury, NY 11590-5114
Phone (516) 226-8373

Other practice location 1

1615 Northern Blvd Ste 106
Manhasset, NY 11030-3033
Phone (516) 482-8741

Other names 1

  • Krista Lynn Neal Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190613001426 NY Practitioner - Obstetrics/Gynecology 2163776444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.62 of 100Reported as group
Quality
88.76
Promoting interoperability
100
Improvement activities
40
Cost
69.99

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
299420NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Square Care Medical Group, LLP Obstetrics & Gynecology CurrentSince Jul 15, 2019 Accepting new patients

Locations

1615 Northern Blvd
Ste 106
Manhasset, NY 11030
Phone (516) 365-2500

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

900 Merchants Concourse
Ste 216
Westbury, NY 11590
Phone (516) 565-6322

40 Crossways Park Dr
Ste 101
Woodbury, NY 11797
Phone (516) 496-3900

40 Crossways Park Dr
Woodbury, NY 11797
Phone (516) 496-3900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15987/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1063806552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MERCHANTS CONCOURSE STE 216",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115905114",
            "telephone_number": "516-226-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CROSSWAYS PARK DR STE 101",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117972038",
            "telephone_number": "516-496-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Northern Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303033",
            "country_code": "US",
            "telephone_number": "516-482-8741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "KRISTA",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-24",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "299420",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NY",
            "license": "299420",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "299420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "NEAL",
            "middle_name": "LYNN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Woodbury, NY

Sources for this page

Verify at the official NPI Registry.