NPIMap

Individual provider Active NPI

Stephanie J Krusz, MD

  • Internal Medicine Physician
  • Cranston, RI
National Provider Identifier
1467553883
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9044 Issued in RI
Practice address
750 Reservoir Ave
Cranston, RI 02910
Phone
(401) 464-6617
Fax
(401) 464-6673
NPI assigned
Sep 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9044 RI Primary

Addresses

Primary practice location

750 Reservoir Ave
Cranston, RI 02910

Mailing address

905 Pontiac Ave
Cranston, RI 02920-7903
Phone (401) 464-6617

Other identifiers 8

IdentifierTypeStateIssuer
291657OtherRIBLUE CROSS
408319OtherRIB CHIP
4213OtherNHOOD
2590935OtherAETNA
9023286MedicaidRI
04066U2OtherUNITED
404753OtherTUFTS
0757040OtherCIGNA

Other names 1

  • Ms. Stephanie J M Phillips Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20050216000285 RI Practitioner - Internal Medicine 0446202857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Warren Alpert Medical School of Brown University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

120 Centerville Rd
Warwick, RI 02886-4336
Phone (401) 782-8000

268 Post Rd
Suite 203
Westerly, RI 02891-6601
Phone (401) 604-2530

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9044RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Spring Health Care Management, Inc. Internal Medicine CurrentSince Nov 5, 2020 Accepting new patients
Silver Spring Health Care Management, Inc. CurrentSince Nov 5, 2020 Accepting new patients
Silver Spring Health Care Management, Inc Past Accepting new patients
Cedar Crest Nursing Centre Inc PastSince Jan 2, 2025 Accepting new patients

Locations

905 Pontiac Ave
Cranston, RI 02920
Phone (401) 464-6617

100 Kenyon Ave
Wakefield, RI 02879
Phone (401) 782-8000

120 Centerville Rd
Ste 2
Warwick, RI 02886
Phone (401) 562-1020

268 Post Rd
Ste 203
Westerly, RI 02891
Phone (401) 604-2530

Interoperability endpoints

  • Direct secure messaging: skrusz@scmg.gwaydirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cedar Crest Nursing Centre IncCranston, RI, CCN 415032 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 2, 2025
Jan 2, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1467553883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 PONTIAC AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029207903",
            "telephone_number": "401-464-6617",
            "fax_number": "401-464-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 RESERVOIR AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "02910",
            "telephone_number": "401-464-6617",
            "fax_number": "401-464-6673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSZ",
        "first_name": "STEPHANIE",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "9044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "291657",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B CHIP",
            "identifier": "408319",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHOOD",
            "identifier": "4213",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2590935",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9023286",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "04066U2",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "404753",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0757040",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "PHILLIPS",
            "middle_name": "J M",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.