NPIMap

Individual provider Active NPI

Kortney Rose Gugumuck, PA-C

  • Physician Assistant
  • West Coxsackie, NY
National Provider Identifier
1326654633
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
025618 Issued in NY
Practice address
11835 RT 9W
West Coxsackie, NY 12192-3605
Phone
(518) 264-9000
NPI assigned
Sep 22, 2020
Last updated
Jun 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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 025618 NY Primary

Addresses

Primary practice location

11835 RT 9W
West Coxsackie, NY 12192-3605

Mailing address

4104 State Highway 30
Amsterdam, NY 12010-6202
Phone (609) 217-5649

Other practice location 1

2976 Route 9W
Saugerties, NY 12477-5234
Phone (518) 264-9000

Other names 1

  • Kortney Rose Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20201207001773 NY Practitioner - Physician Assistant 0749692267 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

99 E State St
Gloversville, NY 12078-1203
Phone (518) 773-5690

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince Nov 1, 2020 Accepting new patients
Albany Medical College Single Specialty CurrentSince Nov 1, 2020 Accepting new patients
Albany Medical College CurrentSince Nov 1, 2020 Accepting new patients
Nathan Littauer Hospital & Nursing Home CurrentSince Mar 21, 2022 Accepting new patients
Nathan Littauer Hospital Association Single Specialty CurrentSince Mar 21, 2022 Accepting new patients
Albany Medical College Single Specialty Past Accepting new patients

Locations

98 Wolf Rd
Ste 16
Albany, NY 12205
Phone (518) 264-9500

4104 State Highway 30
Amsterdam, NY 12010
Phone (518) 883-8620

99 E State St
Gloversville, NY 12078
Phone (518) 773-5690

23 S Perry St
Johnstown, NY 12095
Phone (518) 736-1500

7 Price Chopper Plz
Mechanicville, NY 12118

1275 Broadway
Menands, NY 12204
Phone (518) 262-9705

2976 Route 9W
Saugerties, NY 12477
Phone (518) 264-9400

115 Saratoga Rd
Ste 110
Schenectady, NY 12302
Phone (518) 264-2900

11835 Route 9W
West Coxsackie, NY 12192
Phone (518) 731-9000

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

Hospital & facility affiliations 4

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": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1326654633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4104 STATE HIGHWAY 30",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120106202",
            "telephone_number": "609-217-5649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 RT 9W",
            "city": "WEST COXSACKIE",
            "state": "NY",
            "postal_code": "121923605",
            "telephone_number": "518-264-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2976 Route 9W",
            "address_purpose": "LOCATION",
            "city": "Saugerties",
            "state": "NY",
            "postal_code": "124775234",
            "country_code": "US",
            "telephone_number": "518-264-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUGUMUCK",
        "first_name": "KORTNEY",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KORTNEY",
            "last_name": "SMITH",
            "middle_name": "ROSE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Coxsackie, NY

Sources for this page

Verify at the official NPI Registry.