NPIMap

Individual provider Active NPI

Kelly Sansouci Gidusko, MD

  • Anesthesiology Physician
  • Harrisburg, PA
National Provider Identifier
1851437958
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD430016 Issued in PA
Practice address
111 S Front St
Harrisburg, PA 17101-2010
Phone
(717) 782-5118
Fax
(717) 782-5854
NPI assigned
Jan 29, 2007
Last updated
Oct 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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 MD430016 PA Primary

Addresses

Primary practice location

111 S Front St
Harrisburg, PA 17101-2010

Mailing address

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 782-5118

Other practice location 1

252 S 4th St
Lebanon, PA 17042-6111
Phone (717) 270-7500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgidusko57858@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110427000009 PA Practitioner - AnesthesiologyPractitioner - Pain Management 8325189475 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Temple University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 782-3282

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Anesthesia Associates, LTD Anesthesiology CurrentSince Sep 1, 2017 Accepting new patients
North American Partners in Anesthesia, Pennsylvania , LLC Anesthesiology CurrentSince Aug 20, 2023 Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC Anesthesiology CurrentSince Nov 16, 2023 Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC CurrentSince Nov 16, 2023 Accepting new patients
York Anesthesiology Physician Services LLC Anesthesiology Past Accepting new patients
Memorial Hospital Anesthesiology Past Accepting new patients

Locations

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

1 Rutherford Rd
Ste 101
Harrisburg, PA 17109
Phone (717) 545-5256

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

4300 Londonderry Rd
Lower Paxton, PA 17109
Phone (717) 597-7044

8835 Germantown Ave
Philadelphia, PA 19118
Phone (215) 248-8227

Interoperability endpoints

  • Direct secure messaging: kgidusko288472@upmc.direct-ci.com

Organizations & group practices 6

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 7

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1851437958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S FRONT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171012010",
            "telephone_number": "717-782-5118",
            "fax_number": "717-782-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S FRONT ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171012010",
            "telephone_number": "717-782-5118",
            "fax_number": "717-782-5854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "252 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426111",
            "country_code": "US",
            "telephone_number": "717-270-7500",
            "fax_number": "717-228-1642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIDUSKO",
        "first_name": "KELLY",
        "middle_name": "SANSOUCI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD430016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgidusko57858@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "111 S Front St",
            "city": "Harrisburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "171012010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

Verify at the official NPI Registry.