Stephanie Nicole Condodemetraky, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

055471-23 Issued in NH

Practice address

775 S. Main St.
Manchester Medical Group
Manchester, NH 03102-5143

Phone

(603) 663-7300

Fax

(603) 663-7333

NPI assigned

Mar 13, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stephanie Nicole Condodemetraky Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Catholic Medical Center

  • Internal Medicine Physician
  • Manchester, NH
  • NPI 1265487755
  Medicare reassignment NPD
• Catholic Medical Center

  • Anesthesiology Physician
  • Manchester, NH
  • NPI 1003692112
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1295976777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 S. MAIN ST.",
            "address_2": "MANCHESTER MEDICAL GROUP",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031025143",
            "telephone_number": "603-663-7300",
            "fax_number": "603-663-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 S. MAIN ST.",
            "address_2": "MANCHESTER MEDICAL GROUP",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031025143",
            "telephone_number": "603-663-7300",
            "fax_number": "603-663-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDODEMETRAKY",
        "first_name": "STEPHANIE",
        "middle_name": "NICOLE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-13",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NH",
            "license": "055471-21",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NH",
            "license": "055471-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "staff_qcma@gohnh.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "775 S. Main St.",
            "address_2": "Manchester Medical Group",
            "city": "Manchester",
            "state": "NH",
            "country_code": "US",
            "postal_code": "031025143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "CONDODEMETRAKY",
            "middle_name": "NICOLE",
            "credential": "RN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Complete Care Counseling
• David Condon, MD
• Grace Elizabeth Condon, PA-C
• Courtney Conerly
• Jennifer Lyn Conley, MA, LMHC
• Kaitlyn Connaghan

• Nurse Practitioner in Manchester, NH
• Providers in Manchester, NH by specialty
• Nurse Practitioner in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.