NPIMap

Individual provider Active NPI

Kristen Marie Siracuse, NP

  • Family Nurse Practitioner
  • Dunkirk, NY
National Provider Identifier
1902213168
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F338541-1 Issued in NY
Practice address
319 Central Ave
Level B
Dunkirk, NY 14048-2137
Phone
(716) 363-6050
Fax
(716) 363-6851
NPI assigned
Jul 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Health Clinical Nurse Specialist 364SF0001X F3385411 NY
Family Nurse Practitioner 363LF0000X F338541-1 NY Primary

Addresses

Primary practice location

319 Central Ave
Level B
Dunkirk, NY 14048-2137

Mailing address

18 Birchwood Dr
Fredonia, NY 14063-1204
Phone (716) 672-4600

Other identifiers 1

IdentifierTypeStateIssuer
04007530MedicaidNY

Other names 1

  • Kristen Marie Schober Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150526000033 NY Practitioner - Nurse Practitioner 5294055786 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Great Lakes Physician PCGroup PAC ID 9133434269, 65 clinicians

Practice addresses (Care Compare)

504 Central Ave
Dunkirk, NY 14048-2515
Phone (716) 338-9200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.58 of 100Reported as group
Quality
39.81
Promoting interoperability
88
Improvement activities
40
Cost
83.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F3385411NYMDFamily Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Physician, PC CurrentSince Jun 1, 2016 Accepting new patients
Great Lakes Physician, PC CurrentSince Jun 1, 2016 Accepting new patients

Locations

3085 Harlem Rd
Ste 200
Cheektowaga, NY 14225
Phone (716) 844-5000

3085 Harlem Rd
Ste 350
Cheektowaga, NY 14225
Phone (716) 844-5000

504 Central Ave
Dunkirk, NY 14048
Phone (716) 366-9008

117 Foote Ave
Ste 100
Jamestown, NY 14701
Phone (716) 338-9200

117 Foote Ave
#100
Jamestown, NY 14701
Phone (716) 338-9200

Interoperability endpoints

  • Direct secure messaging: ksiracuse@qualitycare.medentdirect.com

Organizations & group practices 3

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.

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": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1902213168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 BIRCHWOOD DR",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140631204",
            "telephone_number": "716-672-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 CENTRAL AVE",
            "address_2": "LEVEL B",
            "city": "DUNKIRK",
            "state": "NY",
            "postal_code": "140482137",
            "telephone_number": "716-363-6050",
            "fax_number": "716-363-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRACUSE",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NY",
            "license": "F3385411",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338541-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04007530",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "SCHOBER",
            "middle_name": "MARIE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dunkirk, NY

Sources for this page

Verify at the official NPI Registry.