Individual provider Active NPI

Katelyn Cassiello

  • Nurse Practitioner
  • Clifton, NJ
National Provider Identifier
1104300029
Registry record updated Jul 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ00852200 Issued in NJ
Practice address
1030 Clifton Ave
Clifton, NJ 07013-3522
Phone
(973) 778-3777
NPI assigned
Sep 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ00852200 NJ Primary

Addresses

Primary practice location

1030 Clifton Ave
Clifton, NJ 07013-3522

Mailing address

1030 Clifton Ave
Clifton, NJ 07013-3522
Phone (973) 778-3777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20190423001132 NJ Practitioner - Nurse Practitioner 8921340928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Physician Services PCGroup PAC ID 3577857333, 593 clinicians

Practice addresses (Care Compare)

108 Jackson St
Apt 6B
Hoboken, NJ 07030-6101
Phone (800) 825-5391

4 Valley Health PLZ
Paramus, NJ 07652-3619
Phone (800) 825-5391

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.05 of 100Reported as apm
Quality
85.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00852200NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Physician Services PC CurrentSince Sep 1, 2019 Accepting new patients
Valley Physician Services, Ny, PC Past Accepting new patients

Locations

1030 Clifton Ave
Clifton, NJ 07013
Phone (973) 777-7377

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

1578 Route 23
Ste 103
Wayne, NJ 07470

Interoperability endpoints

  • Direct secure messaging: katelyn.anderson.1@5622.direct.athenahealth.com

Organizations & group practices 2

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 1

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": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656892800000",
    "number": "1104300029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133522",
            "telephone_number": "973-778-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133522",
            "telephone_number": "973-778-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASSIELLO",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-17",
        "last_updated": "2022-07-04",
        "certification_date": "2022-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00852200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

Verify at the official NPI Registry.