Christa M Ebong, RPA-C
Individual provider Active NPI Physician Assistant · Rifton, NY
NPI 1124095401 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1124095401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 004815 (NY)
- Practice address
- 105 Woodcrest Dr
Rifton, NY 12471-7200 - Phone
- (845) 658-7763
- NPI assigned
- Mar 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Esopus Medical, PC
Practice addresses (Care Compare)
10 Hellbrook Lane
Ulster Park, NY 12487-5209
10 Hellbrook LN
Ulster Park, NY 12487-5209
Phone (845) 658-7763
Hospital & facility affiliations
- Garnet Health Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050606000019 | NY | Practitioner - Physician Assistant | 1254300676 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004815 | NY | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Esopus Dental, PC | Current |
Accepting new patients |
Locations
10 Hellbrook Ln
Ulster Park, NY 12487
Phone (845) 339-6680
Interoperability endpoints
- christa.ebong@931273876307972.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004815 | NY | Yes |
Addresses
Primary practice location
105 Woodcrest Dr
Rifton, NY 12471-7200
Mailing address
10 Hellbrook LN
Ulster Park, NY 12487-5209
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 293859 | Other | NY | HMO - WALDEN |
| 01981635 | Medicaid | NY |
Other providers in Rifton, NY
- Johann Heinrich Arnold
- Leila Audinot
- Esopus Dental, PC
- Esopus Medical, PC
- Celina Goodwin
- Maria N Huleatt
- Katherine Joy Keiderling
All providers in Rifton, NY · Physician Assistant 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 Mar 7, 2023. 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.
- Order and Referring (CMS).
- 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.