Individual provider Active NPI

Jenny Shmushkevich, CRNA

  • Certified Registered Nurse Anesthetist
  • Staten Island, NY
National Provider Identifier
1467797753
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NJ00422600 Issued in NJ
Practice address
355 Bard Ave
Staten Island, NY 10310-1699
Phone
(718) 818-1234
NPI assigned
Nov 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR14071400 NJ
Registered Nurse 163W00000X 581083 NY
Certified Registered Nurse Anesthetist 367500000X 26NJ00422600 NJ Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1699

Mailing address

100 Route 59
Suite 105
Suffern, NY 10901-4927
Phone (845) 357-5775

Other practice location 1

1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6991

Other practice location 2

1305 Walt Whitman Rd Ste 300
Melville, NY 11747-4300
Phone (516) 945-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130509000205 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446497549 Reassigns benefits to 4 organizations
I20240731000792 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446497549

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkway Anesthesia Associates LLCGroup PAC ID 2567758931, 313 clinicians
North American Partners in Anesthesia of New Jersey LLCGroup PAC ID 5890867410, 156 clinicians

Practice addresses (Care Compare)

1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6000

703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2000

99 Beauvoir Ave
Summit, NJ 07901-3533
Phone (908) 522-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
581083NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Marys General Medical Group PC CurrentSince Aug 1, 2024 Accepting new patients
Prime Healthcare Services - St. Mary's Passaic LLC CurrentSince Aug 1, 2024 Accepting new patients
Prime Healthcare Services - St. Mary's Passaic, LLC CurrentSince Aug 1, 2024 Accepting new patients
North American Partners in Anesthesia LLP CurrentSince Jul 1, 2024 Accepting new patients
Parkway Anesthesia Associates LLC CurrentSince Jul 15, 2016 Accepting new patients
North American Partners in Anesthesia of New Jersey LLC CurrentSince May 8, 2019 Accepting new patients

Locations

1 Clara Maass Dr
Belleville, NJ 07109
Phone (973) 450-2008

495 Jack Martin Blvd
Ste 1
Brick, NJ 08724
Phone (732) 836-9800

41 Arthur St
East Brunswick, NJ 08816
Phone (718) 948-8880

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

360 Route 70
Lakewood, NJ 08701
Phone (732) 367-3050

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

300 2nd Ave
Long Branch, NJ 07740
Phone (732) 222-5200

1 Bay Ave
Montclair, NJ 07042
Phone (973) 429-6100

111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060

350 Boulevard
Passaic, NJ 07055
Phone (973) 365-4300

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

865 Stone St
Rahway, NJ 07065
Phone (732) 381-4000

99 Beauvoir Ave
Summit, NJ 07901
Phone (908) 522-2232

99 State Route 37 W
Toms River, NJ 08755
Phone (732) 240-8000

7 Southwoods Blvd
Ste 4
Albany, NY 12211

3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

Organizations & group practices 6

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 3

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": "1354060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1467797753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ROUTE 59",
            "address_2": "SUITE 105",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109014927",
            "telephone_number": "845-357-5775",
            "fax_number": "845-357-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101699",
            "telephone_number": "718-818-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Bay Ave",
            "address_purpose": "LOCATION",
            "city": "Montclair",
            "state": "NJ",
            "postal_code": "070424837",
            "country_code": "US",
            "telephone_number": "973-429-6991",
            "fax_number": "845-357-5777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1305 Walt Whitman Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Melville",
            "state": "NY",
            "postal_code": "117474300",
            "country_code": "US",
            "telephone_number": "516-945-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHMUSHKEVICH",
        "first_name": "JENNY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-28",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR14071400",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "581083",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ00422600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.