Individual provider Active NPI

Katie M. Marcuccio, CRNA

  • Certified Registered Nurse Anesthetist
  • Norwich, CT
National Provider Identifier
1790030567
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
04997 Issued in CT
Practice address
326 Washington St
Dept of Anesthesia
Norwich, CT 06360-2740
Phone
(860) 889-8331
NPI assigned
Jul 18, 2012
Last updated
Dec 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN263394 MA
Certified Registered Nurse Anesthetist 367500000X 04997 CT Primary

Addresses

Primary practice location

326 Washington St
Dept of Anesthesia
Norwich, CT 06360-2740

Mailing address

68 S Service Rd
Suite 350
Melville, NY 11747-2354
Phone (516) 945-3034

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-3271

Other identifiers 1

IdentifierTypeStateIssuer
110130192AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kmarcuccio338088@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121005000058 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 6103075213 Reassigns benefits to 2 organizations
I20200928000486 MA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6103075213 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lawrence Anesthesia Services LLCGroup PAC ID 4082770136, 127 clinicians
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

123 Summer St
Worcester, MA 01608-1216
Phone (508) 363-5000

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
04997CTMDCertified Registered Nurse Anesthetist
RN263394MAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Gi PLLC CurrentSince Oct 1, 2019 Accepting new patients
North American Partners in Anesthesia Connecticut PC CurrentSince Sep 15, 2012 Accepting new patients
Lawrence Anesthesia Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 28, 2022 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Aug 1, 2020 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Aug 1, 2020 Accepting new patients

Locations

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

123 Summer St
Worcester, MA 01608
Phone (508) 363-6000

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107

Interoperability endpoints

  • Direct secure messaging: kmarcuccio338088@umassmemorial.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1790030567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 S SERVICE RD",
            "address_2": "SUITE 350",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117472354",
            "telephone_number": "516-945-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 WASHINGTON ST",
            "address_2": "DEPT OF ANESTHESIA",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602740",
            "telephone_number": "860-889-8331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-3271",
            "fax_number": "508-856-5911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCUCCIO",
        "first_name": "KATIE",
        "middle_name": "M.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "RN263394",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "04997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110130192A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmarcuccio338088@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.