Active NPI
Kristine K Wailgum, APRN
- Adult Health Nurse Practitioner
- Longmeadow, MA
National Provider Identifier
1477524031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 110009
- Practice address
- 770 Converse St
Longmeadow, MA 01106-1719 - Phone
- (413) 567-3949
- Fax
- (413) 567-0175
- NPI assigned
- Jan 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 110009 | MA | Primary |
Addresses
Primary practice location
770 Converse St
Longmeadow, MA 01106-1719
Mailing address
PO Box 789
Ludlow, MA 01056-0789
Phone (413) 509-1000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8303930 | Other | MA | EVERCARE |
| 0710296 | Medicaid | MA | |
| NP2697 | Other | MA | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geriatric Medical Associates PC | Past | Accepting new patients | |
| Primary Care Associates LLC | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/4342/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Geriatric Medicine (Internal Medicine) Physician
- Springfield, MA
- NPI 1063484467
-
- Geriatric Medicine (Internal Medicine) Physician
- Springfield, MA
- NPI 1922070341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1477524031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 789",
"city": "LUDLOW",
"state": "MA",
"postal_code": "010560789",
"telephone_number": "413-509-1000",
"fax_number": "413-509-1003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 CONVERSE ST",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011061719",
"telephone_number": "413-567-3949",
"fax_number": "413-567-0175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAILGUM",
"first_name": "KRISTINE",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-31",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MA",
"license": "110009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "8303930",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0710296",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "NP2697",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.