Kyoungmi Song, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

348436 Issued in NY

Practice address

63 Shaker Rd Ste 201
Albany, NY 12204-1030

Phone

(518) 471-3636

Fax

(518) 471-3668

NPI assigned

Sep 10, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Peter'S Health Partners Medical Associates, P.C.Group PAC ID 6103061189, 480 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Peter'S Hospital Hospital, Albany, NY, CCN 330057
• Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksong1759465@direct.trinity-health.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.

• St. Peter'S Health Partners Medical Associates, P.C.

  • Multi-Specialty Clinic/Center
  • Albany, NY
  • NPI 1750626834
  Medicare reassignment Care Compare group NPD
• Wellnow Urgent Care, PC

  • Urgent Care Clinic/Center
  • Liverpool, NY
  • NPI 1669825162
  Medicare reassignment NPD
• St. Peter'S Health Partners Medical Associates, P.C.

  • Pediatrics Physician
  • Slingerlands, NY
  • NPI 1669717260
  NPD (past)
• Wellnow Urgent Care, PC

  • Urgent Care Clinic/Center
  • Jamestown, NY
  • NPI 1770850224
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727
  Care Compare affiliation
• St. Peter'S Hospital of the City of Albany

  • General Acute Care Hospital
  • Albany, NY
  • NPI 1497701106
  Care Compare affiliation

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1770252991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 SHAKER RD STE 201",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122041030",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Hampstead Pl N Ste 103",
            "address_purpose": "LOCATION",
            "city": "Saratoga Springs",
            "state": "NY",
            "postal_code": "128665669",
            "country_code": "US",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Empire Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "NY",
            "postal_code": "121445730",
            "country_code": "US",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Palisades Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122056433",
            "country_code": "US",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "855 Route 146 Ste 150",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120653874",
            "country_code": "US",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 Hoosick Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121806673",
            "country_code": "US",
            "telephone_number": "518-471-3636",
            "fax_number": "518-471-3668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "KYOUNGMI",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-10",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "63 Shaker Rd Ste 201",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122041030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Sommerville, OT
• Carolyn Sommo
• Megan Sommo, PT
• Scott Sommo, RPH, PHARM D.
• Mira Sonders, SLP
• Cindy L Sonnenschein, OT
• Lavanda Sontag
• Marc Sopper, RN
• Cheryl L Sorbero, DDS
• Carina Aileen Sorenson, M.D.

• Family Nurse Practitioner in Albany, NY
• Providers in Albany, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.