Individual provider Active NPI

Kristen Kratzert, M.D.

  • Gynecology Physician
  • Syracuse, NY
National Provider Identifier
1417908039
Registry record updated Dec 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
156147 Issued in NY
Practice address
739 Irving Ave
Suite 530
Syracuse, NY 13210-1651
Phone
(315) 478-1158
Fax
(315) 478-3014
NPI assigned
May 16, 2006
Last updated
Dec 29, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 156147 NY Primary

Addresses

Primary practice location

739 Irving Ave
Suite 530
Syracuse, NY 13210-1651

Mailing address

739 Irving Ave
Suite 530
Syracuse, NY 13210-1651
Phone (315) 478-1158

Other identifiers 1

IdentifierTypeStateIssuer
01042222MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120111000270 NY Practitioner - Obstetrics/Gynecology 2062467400 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
156147NYMDGynecology Physician

Interoperability endpoints

  • Direct secure messaging: kristen.kratzert.p2@direct.usppny.nextgenshare.com

Organizations & group practices 1

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1417908039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "SUITE 530",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101651",
            "telephone_number": "315-478-1158",
            "fax_number": "315-478-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "SUITE 530",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101651",
            "telephone_number": "315-478-1158",
            "fax_number": "315-478-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRATZERT",
        "first_name": "KRISTEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "156147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01042222",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.