Individual provider Active NPI

Kristofer Willers, MD

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1891290516
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
288089 Issued in MA
Practice address
109 W 27TH St RM 5S
New York, NY 10001-6208
Phone
(833) 351-8255
Fax
(888) 815-3583
NPI assigned
Mar 26, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 314147-01 NY
Psychiatry Physician 2084P0800X A177531 CA
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 288089 MA Primary

Addresses

Primary practice location

109 W 27TH St RM 5S
New York, NY 10001-6208

Mailing address

32 Madison St # 2
Somerville, MA 02143-1209
Phone (617) 804-7970

Other practice location 1

300 Baker Ave Ste 300
Concord, MA 01742-2124
Phone (833) 351-8255

Other practice location 2

100 Pine St Ste 1250
San Francisco, CA 94111-5235
Phone (833) 351-8255

Other names 1

  • Dr. Kristofer Joondeph-Breidbart Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20240926002958 MA Practitioner - Psychiatry 1557617479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Massachusetts Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

265 Franklin St
Suite 1702
Boston, MA 02110-3144
Phone (833) 351-8255

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A177531CAMDPsychiatry Physician
288089MAMDPsychiatry Physician
314147-01NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Sep 23, 2024 Accepting new patients

Locations

265 Franklin St
Ste 1702
Boston, MA 02110
Phone (203) 721-6500

300 Baker Ave
Ste 300
Concord, MA 01742
Phone (864) 336-2731

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

Organizations & group practices 1

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": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1891290516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MADISON ST # 2",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021431209",
            "telephone_number": "617-804-7970",
            "fax_number": "617-203-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Baker Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "MA",
            "postal_code": "017422124",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Pine St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941115235",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLERS",
        "first_name": "KRISTOFER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "314147-01",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A177531",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "288089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTOFER",
            "last_name": "JOONDEPH-BREIDBART",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.