NPIMap

Individual provider Active NPI

Kimberly Thi Serine, PA-C

  • Physician Assistant
  • Plains, PA
National Provider Identifier
1326473596
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
672 S River St Ste 101
Plains, PA 18705-1033
Phone
(570) 552-7170
Fax
(570) 552-7169
NPI assigned
Sep 6, 2013
Last updated
Aug 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

672 S River St Ste 101
Plains, PA 18705-1033

Mailing address

672 S River St Ste 101
Plains, PA 18705-1033
Phone (570) 552-7170

Other practice location 1

201 N Main St
Plains, PA 18705-1509
Phone (570) 270-4699

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kimberly.serine.1@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140415000177 PA Practitioner - Physician Assistant 9133351752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

1099 S Township Blvd
Pittston, PA 18640-3247
Phone (570) 602-2400

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wilkes Barre Hospital Company LLC Past Accepting new patients
Radiology Associates of Wyoming Valley, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kimberly.serine.1@21771.direct.athenahealth.com

Organizations & group practices 3

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 5

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": "1378425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1326473596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "672 S RIVER ST STE 101",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051033",
            "telephone_number": "570-552-7170",
            "fax_number": "570-552-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 S RIVER ST STE 101",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051033",
            "telephone_number": "570-552-7170",
            "fax_number": "570-552-7169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 N Main St",
            "address_purpose": "LOCATION",
            "city": "Plains",
            "state": "PA",
            "postal_code": "187051509",
            "country_code": "US",
            "telephone_number": "570-270-4699",
            "fax_number": "570-270-2625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SERINE",
        "first_name": "KIMBERLY",
        "middle_name": "THI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-06",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimberly.serine.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "672 S River St",
            "city": "Plains",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187051014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plains, PA

Sources for this page

Verify at the official NPI Registry.