Individual provider Active NPI

Kristin Taylor Crouse, D.O.

  • Family Medicine Physician
  • Schenectady, NY
National Provider Identifier
1154771194
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
297120 Issued in NY
Practice address
624 McClellan St Ste 101
Schenectady, NY 12304-1020
Phone
(518) 382-2260
NPI assigned
Jun 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 297120 NY Primary

Addresses

Primary practice location

624 McClellan St Ste 101
Schenectady, NY 12304-1020

Mailing address

624 McClellan St Ste 101
Schenectady, NY 12304-1020
Phone (518) 382-2260

Other names 1

  • Kristin Taylor Kenney Former name

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
I20190730000554 NY Practitioner - Family Practice 3971839986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

624 McClellan St
Schenectady, NY 12304-1020
Phone (518) 382-2260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
297120NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis Hospital CurrentSince Jan 4, 2021 Accepting new patients
Community Care Physicians, PC Past Accepting new patients

Locations

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

711 Troy Schenectady Rd
Ste 201
Latham, NY 12110

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

624 McClellan St
Ste 101
Schenectady, NY 12304
Phone (518) 347-5043

624 McClellan St
Schenectady, NY 12304
Phone (518) 229-3339

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1154771194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST STE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260",
            "fax_number": "518-347-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST STE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROUSE",
        "first_name": "KRISTIN",
        "middle_name": "TAYLOR",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "297120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "KENNEY",
            "middle_name": "TAYLOR",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.