Individual provider Active NPI

Mary Crodelle, CRNA

  • Certified Registered Nurse Anesthetist
  • Kingston, NY
National Provider Identifier
1558354548
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
274347 Issued in NY
Practice address
105 Marys Ave
Benedictine Hospital
Kingston, NY 12401-5848
Phone
(845) 334-3080
NPI assigned
Aug 25, 2005
Last updated
Oct 22, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 274347 NY Primary

Addresses

Primary practice location

105 Marys Ave
Benedictine Hospital
Kingston, NY 12401-5848

Mailing address

43 Kensico Dr
2ND Floor
Mount Kisco, NY 10549-1009
Phone (914) 666-8866

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040715000367 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769461607 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia LLPGroup PAC ID 7719885771, 427 clinicians

Practice addresses (Care Compare)

45 Reade PL
Poughkeepsie, NY 12601-3947
Phone (845) 454-8500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia LLP CurrentSince Jun 30, 2015 Accepting new patients
Cross River Anesthesiologist Services, PC Past Accepting new patients

Locations

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

68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107

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

243 North Rd
Ste 304
Poughkeepsie, NY 12601
Phone (845) 451-7251

45 Reade Pl
Poughkeepsie, NY 12601
Phone (845) 331-3131

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413936000000",
    "number": "1558354548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 KENSICO DR",
            "address_2": "2ND FLOOR",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105491009",
            "telephone_number": "914-666-8866",
            "fax_number": "914-666-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MARYS AVE",
            "address_2": "BENEDICTINE HOSPITAL",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124015848",
            "telephone_number": "845-334-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRODELLE",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2014-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "274347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; 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.