Keriann Michelle Scavone, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

015742 Issued in NY

Practice address

195 Little Albany St
New Brunswick, NJ 08901-1914

Phone

(732) 235-4023

Fax

(732) 235-3299

NPI assigned

Jul 25, 2012

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Keriann Michelle Smith Former name

Medicare fee-for-service enrollment

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kscavone493718@nyumc.direct-ci.com

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.

• Rutgers Health-RWJ Scleroderma Program

  • Allergy & Immunology (Internal Medicine) Physician
  • New Brunswick, NJ
  • NPI 1679655781
  Medicare reassignment
• Rutgers Health-RWJ Primary Medicine Group

  • Internal Medicine Physician
  • New Brunswick, NJ
  • NPI 1992887012
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Psychiatry Physician
  • Piscataway, NJ
  • NPI 1033207378
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Pulmonary Disease Physician
  • New Brunswick, NJ
  • NPI 1275563611
  NPD
• Rutgers Health-RWJ Scleroderma Program

  • Radiation Oncology Physician
  • New Brunswick, NJ
  • NPI 1942249909
  NPD

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1588910772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 LITTLE ALBANY ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011914",
            "telephone_number": "732-235-4023",
            "fax_number": "732-235-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 LITTLE ALBANY ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011914",
            "telephone_number": "732-235-4023",
            "fax_number": "732-235-3299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 E 70th St",
            "address_2": "Starr Pavilion",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100219800",
            "country_code": "US",
            "telephone_number": "646-962-2072",
            "fax_number": "646-962-1603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCAVONE",
        "first_name": "KERIANN",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00373300",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "25MP00373300",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ CDS LICENSE",
            "identifier": "A00379400",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "0157421",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERIANN",
            "last_name": "SMITH",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sara Sawicki
• Abhiraj Saxena
• Sonam Dadoo Saxena
• Matthew Scala, APN
• Michele Scasserra
• Dale Schaar
• Daniel Abraham Schaer, MD
• Robyn Schafer, CNM
• Henry Joel Scharf, MD
• Ryan Collins Scheer

• Physician Assistant in New Brunswick, NJ
• Providers in New Brunswick, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.