NPIMap

Individual provider Active NPI

Kathryn R Stauder, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Great Neck, NY
National Provider Identifier
1427441153
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
430847 Issued in NY
Practice address
310 East Shore Road
Suite #104
Great Neck, NY 11023
Phone
(516) 829-9550
Fax
(516) 829-9718
NPI assigned
Mar 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 430847 NY Primary

Addresses

Primary practice location

310 East Shore Road
Suite #104
Great Neck, NY 11023

Mailing address

310 East Shore Road
Suite #104
Great Neck, NY 11023
Phone (516) 829-9550

Other names 1

  • Mrs. Kathryn R Davis 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
I20170301000931 NY Practitioner - Nurse Practitioner 4688995574 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, P.C CurrentSince Jan 25, 2017 Accepting new patients
New York University CurrentSince Sep 1, 2018 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
New York University CurrentSince Sep 1, 2018 Accepting new patients

Locations

1300 Franklin Ave
Ste ML2
Garden City, NY 11530

310 E Shore Rd
Ste 104
Great Neck, NY 11023
Phone (516) 829-9550

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

Networks

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

Interoperability endpoints

  • Direct secure messaging: khartin30781@nyumc.direct-ci.com
  • Direct secure messaging: kdavis104655@direct-chsli.net

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.

Hospital & facility affiliations 9

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": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1427441153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 EAST SHORE ROAD",
            "address_2": "SUITE #104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11023",
            "telephone_number": "516-829-9550",
            "fax_number": "516-829-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 EAST SHORE ROAD",
            "address_2": "SUITE #104",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11023",
            "telephone_number": "516-829-9550",
            "fax_number": "516-829-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUDER",
        "first_name": "KATHRYN",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-04",
        "last_updated": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "430847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "DAVIS",
            "middle_name": "R",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.