Active NPI
Kristin Ashley Ilaria, PA-C
- Physician Assistant
- Lakewood, NJ
National Provider Identifier
1770839847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00288100
- Practice address
- 600 River Ave
Lakewood, NJ 08701-5237 - Phone
- (732) 886-4525
- NPI assigned
- Jul 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00288100 | NJ | Primary |
Addresses
Primary practice location
600 River Ave
Lakewood, NJ 08701-5237
Mailing address
3300 Churchill Dr
Toms River, NJ 08753-4814
Phone (732) 239-0847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
515 N Wood Ave
Linden, NJ 07036-4038
Phone (908) 925-8877
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023035 | NY | MD | Physical Therapist |
| 25MP00288100 | NJ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology and Skin Surgery Center, Professional Association | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Procedural Dermatology Physician
- Florham Park, NJ
- NPI 1811129141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343260800000",
"number": "1770839847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 CHURCHILL DR",
"city": "TOMS RIVER",
"state": "NJ",
"postal_code": "087534814",
"telephone_number": "732-239-0847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 RIVER AVE",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087015237",
"telephone_number": "732-886-4525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILARIA",
"first_name": "KRISTIN",
"middle_name": "ASHLEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-26",
"last_updated": "2012-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00288100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; 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.