Individual provider Active NPI

Kelly Lynn Yurchak, CRNA

  • Certified Registered Nurse Anesthetist
  • Philadelphia, PA
National Provider Identifier
1477869626
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NR13377600 Issued in NJ
Practice address
111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone
(215) 955-6161
NPI assigned
Aug 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN565907 PA
Certified Registered Nurse Anesthetist 367500000X L10036327 DE
Certified Registered Nurse Anesthetist 367500000X 26NR13377600 NJ Primary

Addresses

Primary practice location

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824

Mailing address

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone (215) 955-6161

Other names 1

  • Kelly L Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160819000821 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870780620 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkway Anesthesia Associates LLCGroup PAC ID 2567758931, 313 clinicians

Practice addresses (Care Compare)

300 Central Ave
East Orange, NJ 07018-2819
Phone (973) 672-8400

Hospital & facility affiliations

  • Inspira Medical Center Mullica Hill Hospital, Elmer, NJ, CCN 310069
  • Inspira Medical Center Vineland Hospital, Vineland, NJ, CCN 310032

Merit-based Incentive Payment System (MIPS)

Final score
89.65 of 100Reported as group
Quality
85.05
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L10036327DEMDCertified Registered Nurse Anesthetist
26NR13377600NJMDCertified Registered Nurse Anesthetist
RN565907PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
South Jersey Anesthesia and Pain Physicians PC CurrentSince Jul 1, 2016 Accepting new patients
Parkway Anesthesia Associates LLC CurrentSince Apr 1, 2025 Accepting new patients

Locations

300 Central Ave
East Orange, NJ 07018
Phone (973) 266-8460

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

163 Bridgeton Pike
Bldg B
Mullica Hill, NJ 08062
Phone (856) 478-4222

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

251 S Lincoln Ave
Vineland, NJ 08361
Phone (856) 691-8188

509 N Broad St
Woodbury, NJ 08096
Phone (856) 686-5396

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.

Hospital & facility affiliations 4

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": "1282780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1477869626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YURCHAK",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-26",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN565907",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "DE",
            "license": "L10036327",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NR13377600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SMITH",
            "middle_name": "L",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.