Individual provider Active NPI

Jason Krellman, PH.D., ABPP-CN

  • Clinical Neuropsychologist
  • New York, NY
National Provider Identifier
1730465063
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
019043 Issued in NY
Practice address
710 W 168TH St
New York, NY 10032-3726
Phone
(646) 426-3876
Fax
(212) 305-1145
NPI assigned
Nov 1, 2011
Last updated
Feb 13, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 019043 NY Primary

Addresses

Primary practice location

710 W 168TH St
New York, NY 10032-3726

Mailing address

710 W 168TH St
New York, NY 10032-3726
Phone (646) 426-3876

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120719000092 NY Practitioner - Clinical Psychologist 3577729581 Reassigns benefits to 2 organizations
Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

51 W 51St St
FL 3 Suite 360
New York, NY 10019-6113
Phone (212) 326-8426

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
019043NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince May 1, 2013 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince May 1, 2013 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 1, 2018 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 1, 2018 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology Past Accepting new patients

Locations

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

51 W 51st St
Ste 360
New York, NY 10019
Phone (212) 326-8415

710 W 168th St
#1125A
New York, NY 10032
Phone (212) 342-4437

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

710 W 168th St
New York, NY 10032
Phone (212) 305-0217

Networks

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

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1730465063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323726",
            "telephone_number": "646-426-3876",
            "fax_number": "212-305-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323726",
            "telephone_number": "646-426-3876",
            "fax_number": "212-305-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRELLMAN",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "PH.D., ABPP-CN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-01",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "019043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.