Individual provider Active NPI

Anna Kryuchkova, MD

  • Anesthesiology Physician
  • Staten Island, NY
National Provider Identifier
1790883320
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
00219931 Issued in NY
Practice address
2223 Clove Rd
Staten Island, NY 10305-1523
Phone
(917) 449-5986
Fax
(718) 849-6523
NPI assigned
Sep 20, 2006
Last updated
Mar 9, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 00219931 NY Primary

Addresses

Primary practice location

2223 Clove Rd
Staten Island, NY 10305-1523

Mailing address

2223 Clove Rd
Staten Island, NY 10305-1523
Phone (917) 449-5986

Other identifiers 3

IdentifierTypeStateIssuer
5303487OtherNYGHI
02253703MedicaidNY
8L0251OtherNYBLUE SHIELD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080812000167 NY Practitioner - Anesthesiology 4587739479 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PPG Anesthesia PLLCGroup PAC ID 8022165588, 10 clinicians
Igor Amigud Physician P CGroup PAC ID 8729016878, 7 clinicians

Practice addresses (Care Compare)

1765 E 19TH St
Brooklyn, NY 11229-2233
Phone (646) 620-6485

2569 Ocean Ave
Brooklyn, NY 11229-4576
Phone (718) 332-3100

5091 Amboy Rd
Staten Island, NY 10312-4722
Phone (646) 620-6485

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00219931NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Igor Amigud Physician P.C. CurrentSince Sep 23, 2017 Accepting new patients
Goldstep Ambulatory Surgery Center, LLC Anesthesiology CurrentSince Mar 1, 2017 Accepting new patients
PPG Anesthesia, PLLC Anesthesiology CurrentSince Mar 1, 2018 Accepting new patients
Ef Anesthesia and Pain Management Services P C Anesthesiology CurrentSince Mar 20, 2017 Accepting new patients

Locations

2269 Ocean Ave
Brooklyn, NY 11229
Phone (718) 339-8200

3007 Farragut Rd
Brooklyn, NY 11210
Phone (347) 915-1177

2454 Hylan Blvd
Staten Island, NY 10306
Phone (718) 233-1300

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1790883320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 CLOVE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051523",
            "telephone_number": "917-449-5986",
            "fax_number": "718-849-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 CLOVE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051523",
            "telephone_number": "917-449-5986",
            "fax_number": "718-849-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRYUCHKOVA",
        "first_name": "ANNA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "00219931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5303487",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02253703",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "8L0251",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.