Stacy Koch, RN, CCRN
Individual provider Active NPI Certified Registered Nurse Anesthetist · Clarence, NY
NPI 1104291798 · NPPES record last updated May 23, 2019
Key facts
- NPI
- 1104291798
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 118382 (NY)
- Practice address
- 9665 Rocky PT
Clarence, NY 14031-1588 - Phone
- (716) 759-7717
- NPI assigned
- Dec 8, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Parkside Medical Anesthesia Associates
Ambulatory Medical Anesthesia Service PC
Practice addresses (Care Compare)
2157 Main St
Buffalo, NY 14214-2648
Phone (716) 836-7510
945 Sweet Home Rd
Amherst, NY 14226-1241
Phone (716) 831-9435
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180720001677 | NY | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4082961115 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118382 | NY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Buffalo Surgery Center LLC | Current |
Accepting new patients | |
| Parkside Medical Anesthesia Associates | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Ambulatory Medical Anesthesia Service, PC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
Locations
3921 Sheridan Dr
Buffalo, NY 14226
Phone (716) 250-6520
945 Sweet Home Rd
Buffalo, NY 14226
Phone (716) 831-9435
3871 Harlem Rd
Ste 202
Buffalo, NY 14215
2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 118382 | NY | Yes |
Addresses
Primary practice location
9665 Rocky PT
Clarence, NY 14031-1588
Mailing address
9665 Rocky PT
Clarence, NY 14031-1588
Other providers in Clarence, NY
- Lindsay Karas
- April Kilgour
- David Joseph King
- Kari Klentos
- KMC Nurse Practitioner in Adult Health PLLC
- Sara Kreher
- Lori Theresa Kuhmann
- Richard B Lafountain
- Stephanie B Lanza
- Jennifer Lasly
All providers in Clarence, NY · Certified Registered Nurse Anesthetist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.