Individual provider Active NPI

Shana Rudinsky, PA-C

  • Physician Assistant
  • Newburgh, NY
National Provider Identifier
1801361431
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022762 Issued in NY
Practice address
147 Lake St
Newburgh, NY 12550-5263
Phone
(845) 563-8000
NPI assigned
Oct 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022762 NY Primary

Addresses

Primary practice location

147 Lake St
Newburgh, NY 12550-5263

Mailing address

2570 Route 9W Ste 10
Cornwall, NY 12518-1370
Phone (845) 220-3100

Other practice location 1

45 Reade Pl
Poughkeepsie, NY 12601-3947
Phone (845) 454-8500

Other identifiers 1

IdentifierTypeStateIssuer
05436122MedicaidNY

Other names 1

  • Shana Obermeit Former name

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
I20190110002196 NY Practitioner - Physician Assistant 8729324835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Family HealthcareGroup PAC ID 4880610393, 67 clinicians

Practice addresses (Care Compare)

140 Hammond St
Port Jervis, NY 12771-2607
Phone (845) 563-8000

147 Lake St
Newburgh, NY 12550-5263
Phone (845) 563-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
022762NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Family Healthcare CurrentSince Jan 24, 2022 Accepting new patients
Cornerstone Family Healthcare CurrentSince Jan 24, 2022 Accepting new patients

Locations

2570 US Highway 9W
Ste 10
Cornwall, NY 12518
Phone (845) 220-3100

10 Benton Ave
Middletown, NY 10940
Phone (845) 343-0881

147 Lake St
Newburgh, NY 12550

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGCECD
  • Direct secure messaging: shana.rudinsky@csfh.eclinicaldirectplus.com

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, 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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1801361431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 LAKE ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125505263",
            "telephone_number": "845-563-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Reade Pl",
            "address_purpose": "LOCATION",
            "city": "Poughkeepsie",
            "state": "NY",
            "postal_code": "126013947",
            "country_code": "US",
            "telephone_number": "845-454-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUDINSKY",
        "first_name": "SHANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-10",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05436122",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANA",
            "last_name": "OBERMEIT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newburgh, NY

Sources for this page

Verify at the official NPI Registry.