Krystyna McNicoll, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A42084 Issued in CA

Practice address

881 Alma Real Dr Ste 101
Pacific Palisades, CA 90272-3792

Phone

(310) 829-8923

Fax

(424) 212-5936

NPI assigned

Aug 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

90.42 of 100Reported as group

Quality

96.07

Promoting interoperability

100

Improvement activities

40

Cost

71.98

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmcnicoll595739@oc.providencedirect.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.

• Pacific Palisades Medical Group Inc.

  • Family Medicine Physician
  • Pacific Palisades, CA
  • NPI 1215037049
  Medicare reassignment NPD
• Providence Saint Johns Medical Foundation

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734

  Family Medicine

  Medicare reassignment NPD
• Providence Saint Johns Medical Foundation

  • Family Medicine Physician
  • Santa Monica, CA
  • NPI 1518438712
  NPD
• Saint John'S Health Clinic

  • Specialist
  • Santa Monica, CA
  • NPI 1336438902
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1750392247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR STE 101",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR STE 101",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723792",
            "telephone_number": "310-829-8923",
            "fax_number": "424-212-5936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15200 W Sunset Blvd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Pacific Palisades",
            "state": "CA",
            "postal_code": "902723620",
            "country_code": "US",
            "telephone_number": "310-459-7736",
            "fax_number": "310-230-0284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCNICOLL",
        "first_name": "KRYSTYNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A42084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A420840",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmcnicoll595739@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "881 Alma Real Dr Ste 101",
            "city": "Pacific Palisades",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902723792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracy G Marsh, PH.D.
• Max Moncayo DDS Dental Corporation
• Darby McCullough
• Bernadette Catherine McDonnell, PT, LCCE
• Danielle McLellan-Bujnak, ICPD
• Joanne Gail Mednick, MFT
• Miriam Anne Meyer, MSW
• Carol Lynn Meylan, LCSW
• Michael R Block M D Inc
• Peggy G. Miller, MFT

• Family Medicine Physician in Pacific Palisades, CA
• Providers in Pacific Palisades, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.