NPIMap

Individual provider Active NPI

Deanna M Krolick, PAC

  • Medical Physician Assistant
  • Smithtown, NY
National Provider Identifier
1639484207
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
014133 Issued in NY
Practice address
48 Route 25a Ste 301
Smithtown, NY 11787-1454
Phone
(631) 862-3171
Fax
(631) 862-3180
NPI assigned
Aug 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Medical Physician Assistant 363AM0700X 014133 NY Primary

Addresses

Primary practice location

48 Route 25a Ste 301
Smithtown, NY 11787-1454

Mailing address

48 Route 25a Ste 301
Smithtown, NY 11787-1454
Phone (631) 862-3171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170117000541 NY Practitioner - Physician Assistant 5991087538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of New York at Stony Brook, School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347

1000 N Village Ave
Rockville Center, NY 11570-1000

48 Route 25a
Suite 7
Smithtown, NY 11787-1431
Phone (516) 627-5262

50 Route 25a
Smithtown, NY 11787-1348
Phone (631) 862-3000

Hospital & facility affiliations

  • St Catherine of Siena Hospital Hospital, Smithtown, NY, CCN 330401
  • Good Samaritan Hospital Medical Center Hospital, West Islip, NY, CCN 330286
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014133NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, PC CurrentSince Dec 15, 2016 Accepting new patients
CHS Physician Partners, P.C CurrentSince Dec 15, 2016 Accepting new patients

Locations

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

48 Route 25A
Ste 301
Smithtown, NY 11787
Phone (516) 724-1000

Networks

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

Interoperability endpoints

  • Direct secure messaging: dkrolik64251@direct-chsli.net

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 9

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": "1281225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510876800000",
    "number": "1639484207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A STE 301",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871454",
            "telephone_number": "631-862-3171",
            "fax_number": "631-862-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A STE 301",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871454",
            "telephone_number": "631-862-3171",
            "fax_number": "631-862-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROLICK",
        "first_name": "DEANNA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-08",
        "last_updated": "2017-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "014133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

Verify at the official NPI Registry.