Individual provider Active NPI

Kristin E Mullally, NP

  • Family Nurse Practitioner
  • East Syracuse, NY
National Provider Identifier
1508014028
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F335609 Issued in NY
Practice address
4939 Brittonfield Pkwy
Suite 101
East Syracuse, NY 13057-9208
Phone
(315) 463-1600
Fax
(315) 634-6789
NPI assigned
Sep 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F335609 NY Primary

Addresses

Primary practice location

4939 Brittonfield Pkwy
Suite 101
East Syracuse, NY 13057-9208

Mailing address

4939 Brittonfield Pkwy
Suite 101
East Syracuse, NY 13057-9208
Phone (315) 463-1600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090803000432 NY Practitioner - Nurse Practitioner 7618020017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cny Family Care LLPGroup PAC ID 6901710896, 29 clinicians

Practice addresses (Care Compare)

4939 Brittonfield Pkwy
Suite 101
East Syracuse, NY 13057-9208
Phone (315) 463-1600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F335609NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cny Family Care, LLP CurrentSince May 12, 2011 Accepting new patients

Locations

4939 Brittonfield Pkwy
Ste 101
East Syracuse, NY 13057
Phone (315) 463-1600

Interoperability endpoints

  • Direct secure messaging: kmullally@cnyfamilycare.medentdirect.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305244800000",
    "number": "1508014028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4939 BRITTONFIELD PKWY",
            "address_2": "SUITE 101",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579208",
            "telephone_number": "315-463-1600",
            "fax_number": "315-634-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4939 BRITTONFIELD PKWY",
            "address_2": "SUITE 101",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579208",
            "telephone_number": "315-463-1600",
            "fax_number": "315-634-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "KRISTIN",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2011-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F335609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.