Individual provider Active NPI

Mary Philomena Kastner, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Walnut Creek, CA
National Provider Identifier
1073664231
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP17412 Issued in CA
Practice address
2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945
Phone
(800) 892-2695
NPI assigned
Jan 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP17412 CA Primary

Addresses

Primary practice location

2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945

Mailing address

2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945
Phone (800) 892-2695

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070706000355 CA Practitioner - Certified Clinical Nurse Specialist (CNS) 1557461464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bright Heart Health Medical Group a Medical CorporationGroup PAC ID 2264775790, 11 clinicians

Practice addresses (Care Compare)

2960 Camino Diablo
Suite 105
Walnut Creek, CA 94597-3945
Phone (800) 892-2695

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NP17412CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Heart Health Medical Group a Medical Corporation CurrentSince Aug 1, 2022 Accepting new patients

Locations

2960 Camino Diablo
Ste 105
Walnut Creek, CA 94597
Phone (631) 759-0623

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": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1073664231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945",
            "telephone_number": "800-892-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945",
            "telephone_number": "800-892-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASTNER",
        "first_name": "MARY",
        "middle_name": "PHILOMENA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP17412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.