Katiuschka Nunez, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

190780-1 Issued in NY

Practice address

4 Brewster CT
Setauket, NY 11733-1424

Phone

(631) 751-0619

Fax

(631) 751-0619

NPI assigned

Aug 4, 2011

Reactivated

Nov 13, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Kati Willoughby Other name

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Family Practice

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Public Health Management CorporationGroup PAC ID 1850307406, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: knunez579465@direct.ochin.org

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.

• Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1881779866
  Medicare reassignment Care Compare group NPD
• Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1053847053
  NPD
• Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1467776989
  NPD
• Public Health Mangement Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1912943457
  NPD (past)

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1699054916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BREWSTER CT",
            "city": "SETAUKET",
            "state": "NY",
            "postal_code": "117331424",
            "telephone_number": "631-751-0619",
            "fax_number": "631-751-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 BREWSTER CT",
            "city": "SETAUKET",
            "state": "NY",
            "postal_code": "117331424",
            "telephone_number": "631-751-0619",
            "fax_number": "631-751-0619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNEZ",
        "first_name": "KATIUSCHKA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-04",
        "last_updated": "2019-11-13",
        "deactivation_date": "2016-08-10",
        "reactivation_date": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "190780-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATI",
            "last_name": "WILLOUGHBY",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Family Medicine Physician in Setauket, NY
• Providers in Setauket, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.
• 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.