Active NPI
Kaitlyn Paige Probasco, PA-C
- Physician Assistant
- North Bergen, NJ
National Provider Identifier
1356860308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00453600
- Practice address
- 7600 River Rd
North Bergen, NJ 07047-6217 - Phone
- (732) 644-7256
- NPI assigned
- Sep 11, 2017
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00453600 | NJ | Primary |
Addresses
Primary practice location
7600 River Rd
North Bergen, NJ 07047-6217
Mailing address
53 Ivins Dr
New Egypt, NJ 08533-2810
Phone (732) 644-7256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hackensack Meridian Health Medical Group - Specialty Care PC | Current | Accepting new patients |
Locations
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
7600 River Rd
North Bergen, NJ 07047
Phone (201) 854-5000
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IHJHBD
Organizations & group practices 4
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.
-
- Surgical Critical Care Physician
- Red Bank, NJ
- NPI 1215989249
-
- Emergency Medical Services (Emergency Medicine) Physician
- Secaucus, NJ
- NPI 1548809221
-
- Internal Medicine Physician
- North Bergen, NJ
- NPI 1558475087
-
- Durable Medical Equipment & Medical Supplies
- North Bergen, NJ
- NPI 1215734199
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515974400000",
"number": "1356860308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53 IVINS DR",
"city": "NEW EGYPT",
"state": "NJ",
"postal_code": "085332810",
"telephone_number": "732-644-7256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 RIVER RD",
"city": "NORTH BERGEN",
"state": "NJ",
"postal_code": "070476217",
"telephone_number": "732-644-7256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROBASCO",
"first_name": "KAITLYN",
"middle_name": "PAIGE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-11",
"last_updated": "2018-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00453600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Bergen, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2018; 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.