Active NPI
Kym Van Wicklen, CRNA
- Certified Registered Nurse Anesthetist
- Manhasset, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 417417
- Practice address
- 300 Community Dr
Anesthesia Department
Manhasset, NY 11030-3816 - Phone
- (516) 562-4887
- NPI assigned
- Jul 29, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 417417 | NY | Primary |
Addresses
Primary practice location
300 Community Dr
Anesthesia Department
Manhasset, NY 11030-3816
Mailing address
68 S Service Rd
Suite 350
Melville, NY 11747-2354
Phone (516) 945-3000
Other names 1
- Kym Jensen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
270 Park Ave
Huntington, NY 11743-2787
Phone (631) 351-2000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.78 of 100
- Quality
- 77.53
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.35
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 417417 | NY | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Albany Medical College | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| North American Partners in Anesthesia LLP | Current | Accepting new patients | |
| Albany Medical College | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Albany Medical College | Current | Accepting new patients | |
| Albany Medical College | Current | Accepting new patients | |
| North Shore - Lij Anesthesiology, PC | Current | Accepting new patients | |
| Albany Medical College | Current | Accepting new patients |
Locations
47 New Scotland Ave
#131
Albany, NY 12208
Phone (518) 262-4300
47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773
3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171
10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091
270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308
195 E Main St
Huntington, NY 11743
Phone (631) 385-8677
68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107
1275 Broadway
#106
Menands, NY 12204
Phone (518) 262-9705
1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341
300 Community Dr
Plandome, NY 11030
44 S Bayles Ave
Ste 206
Prt Washingtn, NY 11050
Phone (516) 562-0140
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Organizations & group practices 7
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.
-
- Anesthesiology Physician
- Chappaqua, NY
- NPI 1417401266
-
- Allergy & Immunology Physician
- Albany, NY
- NPI 1497921688
Nurse Anesthetist, Certified Registered
-
- Urgent Care Clinic/Center
- Albany, NY
- NPI 1386038925
-
- Allergy & Immunology Physician
- Albany, NY
- NPI 1386689248
-
- Physical Medicine & Rehabilitation Physician
- Albany, NY
- NPI 1629008537
-
- Anesthesiology Physician
- Albany, NY
- NPI 1841226594
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Melville, NY
- NPI 1649264706
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Huntington, NY
- NPI 1508845322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1306846555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 S SERVICE RD",
"address_2": "SUITE 350",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472354",
"telephone_number": "516-945-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 COMMUNITY DR",
"address_2": "ANESTHESIA DEPARTMENT",
"city": "MANHASSET",
"state": "NY",
"postal_code": "110303816",
"telephone_number": "516-562-4887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WICKLEN",
"first_name": "KYM",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-29",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NY",
"license": "417417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KYM",
"last_name": "JENSEN",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Manhasset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.