Individual provider Active NPI

Devon Leigh Kroesche, RDN

  • Registered Dietitian
  • Pittsburgh, PA
National Provider Identifier
1780357988
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN007487 Issued in PA
Practice address
5750 Baum Blvd Ste 305
Pittsburgh, PA 15206-3793
Phone
(267) 701-3566
NPI assigned
Jul 26, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN007487 PA Primary

Addresses

Primary practice location

5750 Baum Blvd Ste 305
Pittsburgh, PA 15206-3793

Mailing address

5750 Baum Blvd Ste 305
Pittsburgh, PA 15206-3793
Phone (267) 701-3566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210820000330 PA Practitioner - Registered Dietitian Or Nutrition Professional 9133524770 Reassigns benefits to 1 organization
I20260506000942 NY Practitioner - Registered Dietitian Or Nutrition Professional 9133524770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

104 Fairwood Dr
Syracuse, NY 13219-2733

5100 W Genesee St
Camillus, NY 13031-2354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN007487PAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Case Specific Nutrition LLC Dietitian, Registered CurrentSince Aug 9, 2021 Accepting new patients

Locations

5750 Baum Blvd
Ste 306
Pittsburgh, PA 15206
Phone (412) 593-2048

5750 Baum Blvd
Ste 305
Pittsburgh, PA 15206
Phone (267) 701-3566

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.

NPI Registry JSON

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1780357988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 BAUM BLVD STE 305",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152063793",
            "telephone_number": "267-701-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 BAUM BLVD STE 305",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152063793",
            "telephone_number": "267-701-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROESCHE",
        "first_name": "DEVON",
        "middle_name": "LEIGH",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN007487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.