Individual provider Active NPI

Kristin Elizabeth Graham, PA-C

  • Surgical Physician Assistant
  • Poughkeepsie, NY
National Provider Identifier
1316209703
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
015670 Issued in NY
Practice address
45 Reade PL
Poughkeepsie, NY 12601-3947
Phone
(845) 437-3152
NPI assigned
Jun 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 015670 NY Primary
Physician Assistant 363A00000X 015670 NY

Addresses

Primary practice location

45 Reade PL
Poughkeepsie, NY 12601-3947

Mailing address

1351 Route 55
Suite 200
Lagrangeville, NY 12540-5108
Phone (845) 475-9661

Other practice location 1

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-7575

Other identifiers 1

IdentifierTypeStateIssuer
03501186MedicaidNY

Other names 1

  • Miss Kristin Elizabeth Maney Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgraham69919@direct.garnethealth.org Direct Garnet Health Doctors PC

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121016000610 NY Practitioner - Physician Assistant 3072763663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garnet Health Doctors PCGroup PAC ID 8628293545, 165 clinicians

Practice addresses (Care Compare)

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-7575

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.1 of 100Reported as group
Quality
61
Promoting interoperability
100
Improvement activities
40
Cost
72.76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015670NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Garnet Health Doctors PC CurrentSince Nov 7, 2022 Accepting new patients

Locations

707 E Main St
Middletown, NY 10940
Phone (845) 333-1000

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: kgraham69919@direct.garnethealth.org

Organizations & group practices 1

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 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": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1316209703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 ROUTE 55",
            "address_2": "SUITE 200",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405108",
            "telephone_number": "845-475-9661",
            "fax_number": "845-475-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 READE PL",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013947",
            "telephone_number": "845-437-3152"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 E Main St",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "NY",
            "postal_code": "109402650",
            "country_code": "US",
            "telephone_number": "845-333-7575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KRISTIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "015670",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015670",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03501186",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgraham69919@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "707 E Main St",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109402650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "MANEY",
            "middle_name": "ELIZABETH",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.