Individual provider Active NPI

Kristen Dematti

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1851783641
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018466-01 Issued in NY
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(646) 201-2997
NPI assigned
Mar 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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 018466-01 NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

226 Corbin Ave
Staten Island, NY 10308-1874
Phone (646) 201-2997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20210616000679 NJ Practitioner - Physician Assistant 3274815345 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care of New Jersey PA 34 clinicians

Practice addresses (Care Compare)

116 Corporate Blvd
Suite E
South Plainfield, NJ 07080-2437
Phone (908) 757-1424

595 Division St
Elizabeth, NJ 07201-2038
Phone (908) 289-5646

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018466-01NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care of New Jersey PA CurrentSince Jul 11, 2024 Accepting new patients
American Current Care of New Jersey PA Current Accepting new patients
American Current Care of New Jersey PA CurrentSince Jul 11, 2024 Accepting new patients

Locations

595 Division St
Elizabeth, NJ 07201
Phone (908) 289-5646

817 E Gate Dr
#102
Mount Laurel, NJ 08054
Phone (856) 778-1090

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1851783641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 CORBIN AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103081874",
            "telephone_number": "646-201-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "646-201-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTI",
        "first_name": "KRISTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018466-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.