Individual provider Active NPI

Katerina Listopad, ANP-C

  • Adult Health Nurse Practitioner
  • Monroe, NY
National Provider Identifier
1790146744
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F307372 Issued in NY
Practice address
24 Grandview TRL
Monroe, NY 10950-6623
Phone
(845) 614-7001
Fax
(845) 614-7001
NPI assigned
Mar 17, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F307372 NY Primary

Addresses

Primary practice location

24 Grandview TRL
Monroe, NY 10950-6623

Mailing address

24 Grandview TRL
Monroe, NY 10950-6623
Phone (845) 614-7001

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160616001901 NY Practitioner - Nurse Practitioner 3870884190 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
307372NYMDAdult Medicine Physician
F307372NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riddle Medical LLC CurrentSince Apr 11, 2016 Accepting new patients
Rockland Endocrine & Diabetes Services PC CurrentSince May 1, 2019 Accepting new patients

Locations

300 Grant Ave
Lake Katrine, NY 12449
Phone (845) 336-3500

100 Franklin St
Poughkeepsie, NY 12601
Phone (845) 454-4000

156 Route 59
Ste C1
Suffern, NY 10901
Phone (845) 357-3838

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": "1458172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1790146744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GRANDVIEW TRL",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109506623",
            "telephone_number": "845-614-7001",
            "fax_number": "845-614-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GRANDVIEW TRL",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109506623",
            "telephone_number": "845-614-7001",
            "fax_number": "845-614-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTOPAD",
        "first_name": "KATERINA",
        "credential": "ANP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

Verify at the official NPI Registry.