Individual provider Active NPI

Bernice Kostelansky, CRNA

  • Certified Registered Nurse Anesthetist
  • Wilkes Barre, PA
National Provider Identifier
1649291311
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN172344L Issued in PA
Practice address
575 N River St
Wilkes Barre, PA 18764-0999
Phone
(570) 829-8111
NPI assigned
Jul 21, 2006
Last updated
May 23, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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 RN172344L PA Primary

Addresses

Primary practice location

575 N River St
Wilkes Barre, PA 18764-0999

Mailing address

11781 Lee Jackson Memorial Hwy
Suite 550
Fairfax, VA 22033-3309
Phone (571) 777-5102

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110819000404 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9931379492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
360 Anesthesia PLLCGroup PAC ID 5991184863, 112 clinicians

Practice addresses (Care Compare)

575 N River St
Wilkes Barre, PA 18764-0999
Phone (570) 829-8111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia, Pennsylvania , LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2011 Accepting new patients
360 Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2022 Accepting new patients

Locations

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

700 Quincy Ave
Scranton, PA 18510
Phone (570) 340-2100

575 N River St
Wilkes Barre, PA 18764
Phone (570) 552-1300

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1649291311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11781 LEE JACKSON MEMORIAL HWY",
            "address_2": "SUITE 550",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333309",
            "telephone_number": "571-777-5102",
            "fax_number": "703-563-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187640999",
            "telephone_number": "570-829-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTELANSKY",
        "first_name": "BERNICE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN172344L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.