NPIMap

Individual provider Active NPI

Kristin Marie Ruiz, PA-C

  • Medical Physician Assistant
  • Port Jefferson Station, NY
National Provider Identifier
1073207387
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
029974 Issued in NY
Practice address
1010 Route 112 Ste 300
Port Jefferson Station, NY 11776-3386
Phone
(631) 364-9119
NPI assigned
Jun 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 029974 NY Primary

Addresses

Primary practice location

1010 Route 112 Ste 300
Port Jefferson Station, NY 11776-3386

Mailing address

2319 Mill Rd
Ronkonkoma, NY 11779-1406
Phone (631) 848-6964

Other practice location 1

6080 Jericho Tpke Ste 100
Commack, NY 11725-2808
Phone (631) 364-9119

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241018002396 NY Practitioner - Physician Assistant 7810429586 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
True North Medical at North Suffolk, PLLCGroup PAC ID 0345618088, 19 clinicians
Port Emergency Medical Services PCGroup PAC ID 1456376177, 41 clinicians
Siena Emergency Medical Services PCGroup PAC ID 9830257625, 15 clinicians

Practice addresses (Care Compare)

1010 Route 112
Suite 300
Port Jefferson Station, NY 11776-3386
Phone (631) 364-9119

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (240) 686-2300

50 Route 25a
Smithtown, NY 11787-1348
Phone (240) 686-2300

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
029974NYMDSpeech-Language Pathologist

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 3

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 8

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": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1073207387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 MILL RD",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117791406",
            "telephone_number": "631-848-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 ROUTE 112 STE 300",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763386",
            "telephone_number": "631-364-9119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6080 Jericho Tpke Ste 100",
            "address_purpose": "LOCATION",
            "city": "Commack",
            "state": "NY",
            "postal_code": "117252808",
            "country_code": "US",
            "telephone_number": "631-364-9119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "029974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.