Individual provider Active NPI

Christine Marie Kershaw, PA-C

  • Physician Assistant
  • Brightwaters, NY
National Provider Identifier
1396198610
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
404 Potter Blvd
Brightwaters, NY 11718-1830
Phone
(631) 376-0055
NPI assigned
Jul 21, 2016
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

404 Potter Blvd
Brightwaters, NY 11718-1830

Mailing address

404 Potter Blvd
Brightwaters, NY 11718-1830
Phone (631) 376-0055

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
I20170612001775 NY Practitioner - Physician Assistant 2668740853 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

300 Community Dr
Manhasset, NY 11030-3816

300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229

301 E Main St
Bay Shore, NY 11706-8408

330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550

350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845

400 Potter Blvd
Brightwaters, NY 11718-1830
Phone (631) 591-7400

402 Potter Blvd
Brightwaters, NY 11718-1830
Phone (631) 587-1800

404 Potter Blvd
Brightwaters, NY 11718-1830
Phone (631) 376-0055

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019931NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince May 3, 2017 Accepting new patients
North Shore Long Island Jewish Health Care Inc CurrentSince Mar 10, 2018 Accepting new patients

Locations

180 E Main St
Bay Shore, NY 11706
Phone (631) 665-0027

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

440 E Main St
Bay Shore, NY 11706
Phone (516) 280-3733

404 Potter Blvd
Brightwaters, NY 11718
Phone (631) 376-0055

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

284 Pulaski Rd
#2
Greenlawn, NY 11740
Phone (631) 271-1608

270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308

300 Community Dr
Manhasset, NY 11030

27005 76th Ave
North New Hyde Pk, NY 11040

888 Old Country Rd
Plainview, NY 11803
Phone (516) 719-2543

815 Hallock Ave
Port Jefferson Station, NY 11776
Phone (631) 331-7267

118 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 376-0055

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: christinewaldhof@nslijmedgr.allscriptsdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1396198610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830",
            "telephone_number": "631-376-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830",
            "telephone_number": "631-376-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSHAW",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-21",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brightwaters, NY

Sources for this page

Verify at the official NPI Registry.