Individual provider Active NPI

Katrina Ruth Stidham, M.D.

  • Otology & Neurotology Physician
  • Hawthorne, NY
National Provider Identifier
1508952219
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
250862 Issued in NY
Practice address
19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140
Phone
(914) 693-7636
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology Physician 207YX0901X 250862 NY Primary

Addresses

Primary practice location

19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140

Mailing address

19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140
Phone (914) 909-9018

Other practice location 1

1055 Saw Mill River Rd
Ste 101
Ardsley, NY 10502-1045
Phone (914) 693-7636

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Katrina.Stidham@wmchealth.cernerdirect.com Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090324000045 NY Practitioner - OtolaryngologyPractitioner - Other (Physician) 6507814670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Duke University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Woods Rd
Valhalla, NY 10595-1530

19 Bradhurst Ave
Hawthorne, NY 10532-2140

95 Grasslands Rd
Valhalla, NY 10595-1652
Phone (914) 493-6940

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
250862NYMDOtology & Neurotology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Center Advanced Physician Services, PC CurrentSince Mar 1, 2020 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Mar 1, 2020 Accepting new patients
Westchester Medical Center Past Accepting new patients

Locations

1055 Saw Mill River Rd
Ste 101
Ardsley, NY 10502
Phone 9146937636 ext. 129

19 Bradhurst Ave
Ste 3100N
Hawthorne, NY 10532
Phone (914) 231-8373

19 Bradhurst Ave
Ste 3600S
Hawthorne, NY 10532
Phone (914) 909-4578

11 Medical Park Dr
Ste 205
Pomona, NY 10970
Phone (845) 362-1350

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

100 Woods Rd
Fl 3
Valhalla, NY 10595
Phone (914) 533-4111

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: katrina.stidham@wmchealth.cernerdirect.com
  • Direct secure messaging: stidhamk@hiemail.healtheconnections.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/0e5efebe-b60c-458e-971a-ee39e08a2178/

Organizations & group practices 3

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 1

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1508952219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3100N",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-909-9018",
            "fax_number": "914-909-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3100N",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-693-7636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 Saw Mill River Rd",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Ardsley",
            "state": "NY",
            "postal_code": "105021045",
            "country_code": "US",
            "telephone_number": "914-693-7636",
            "fax_number": "914-693-5994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "KATRINA",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "NY",
            "license": "250862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Katrina.Stidham@wmchealth.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "19 Bradhurst Ave Ste 3100N",
            "city": "Hawthorne",
            "state": "NY",
            "country_code": "US",
            "postal_code": "105322140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hawthorne, NY

Sources for this page

Verify at the official NPI Registry.