Individual provider Active NPI

Kristine Lynn Tenebruso, MD

  • Internal Medicine Physician
  • Rochester, NY
National Provider Identifier
1093808206
Registry record updated Feb 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
203476 Issued in NY
Practice address
1425 Portland Ave
Rochester, NY 14621-3001
Phone
(585) 922-9080
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 203476 NY
Internal Medicine Physician 207R00000X 203476 NY Primary

Addresses

Primary practice location

1425 Portland Ave
Rochester, NY 14621-3001

Mailing address

100 Kings Hwy S
Rochester, NY 14617-5504
Phone (585) 922-1469

Other practice location 1

2 Coulter Rd
Clifton Springs, NY 14432-1122
Phone (315) 462-1911

Other practice location 2

1200 Driving Park Ave
Newark, NY 14513-1090
Phone (315) 359-2847

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
I20050616000202 NY Practitioner - Internal Medicine 1759325111 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
203476NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clifton Springs Sanitarium Co CurrentSince Feb 1, 2019 Accepting new patients
Newark Wayne Community Hospital CurrentSince Apr 25, 2013 Accepting new patients
Newark Wayne Community Hospital CurrentSince Apr 25, 2013 Accepting new patients
Rochester General Hospital Internal Medicine Current Accepting new patients
Rochester General Hospital CurrentSince Oct 21, 2010 Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

1200 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2266

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

Organizations & group practices 5

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1093808206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS HWY S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175504",
            "telephone_number": "585-922-1469",
            "fax_number": "585-922-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-9080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Coulter Rd",
            "address_purpose": "LOCATION",
            "city": "Clifton Springs",
            "state": "NY",
            "postal_code": "144321122",
            "country_code": "US",
            "telephone_number": "315-462-1911",
            "fax_number": "315-462-2430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Driving Park Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NY",
            "postal_code": "145131090",
            "country_code": "US",
            "telephone_number": "315-359-2847",
            "fax_number": "315-359-2806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TENEBRUSO",
        "first_name": "KRISTINE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "203476",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "203476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.