Kirsty E Bortnik, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

32126 Issued in CA

Practice address

1301 20TH St Ste 150
Santa Monica, CA 90404-2050

Phone

(310) 458-2764

NPI assigned

Jun 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

90.42 of 100Reported as group

Quality

96.07

Promoting interoperability

100

Improvement activities

40

Cost

71.98

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kbortnik1623089@oc.providencedirect.org

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.

• Vivek a Mehta MD Inc

  • Neurological Surgery Physician
  • Irvine, CA
  • NPI 1770112039
  Medicare reassignment
• Saint John'S Health Clinic

  • Specialist
  • Santa Monica, CA
  • NPI 1336438902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1376748780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1493",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910254493",
            "telephone_number": "212-305-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 20TH ST STE 150",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042050",
            "telephone_number": "310-458-2764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323726",
            "country_code": "US",
            "telephone_number": "212-305-3247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORTNIK",
        "first_name": "KIRSTY",
        "middle_name": "E",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-15",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32126",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "019916",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "32126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbortnik1623089@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1301 20th St Ste 150",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904042050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Borer Newman LLC
• Borgardt Psychotherapy
• Jim Borgardt, LMFT
• Maarten W Borghans
• Shaun Bornstein, MTOM
• Bailey Borup
• Jessica Bren Boston, M.D.
• Luca Bosurgi, DHYP, MBSH
• Nyaduar Both
• Dalia Y Botros

• Clinical Neuropsychologist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.
• 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.

Verify at the official NPI Registry.