Kim Ann Vitacco, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F303866 Issued in NY

Practice address

Kim a Vitacco Anp-C
2 Shelter Harbor Court
Wading River, NY 11792-2202

Phone

(631) 886-1668

Fax

(631) 886-1909

NPI assigned

Aug 9, 2005

Reactivated

Jun 14, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

State University of New York at Stony Brook, School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• VNS & Hospice of Suffolk Inc Chha Home health agency, Northport, NY, CCN 337014
• Wellbound Home health agency, Brooklyn, NY, CCN 337450
• Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
• Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
• Constellation Home Care Home health agency, Syosset, NY, CCN 337447

Merit-based Incentive Payment System (MIPS)

Final score

20.51 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

68.38

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• St. Charles Hospital

  • General Acute Care Hospital
  • Wading River, NY
  • NPI 1639225816
  NPD (past) Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• QC-Medi New York, Inc.

  dba CenterWell Home Health

  • Home Health Agency
  • Hauppauge, NY
  • NPI 1376575977
  Care Compare affiliation Name & address match
• Constellation Home Care LLC

  • Home Health Agency
  • Syosset, NY
  • NPI 1841629698
  Care Compare affiliation
• Tender Loving Care Health Care Services of Nassau Suffolk, LLC

  dba Tender Loving Care, an Amedisys Company

  • Home Health Agency
  • Medford, NY
  • NPI 1699715961
  Care Compare affiliation
• Visiting Nurse Service and Hospice of Suffolk Inc.

  • Home Health Agency
  • Northport, NY
  • NPI 1356494637
  Care Compare affiliation
• Visiting Nurse Service and Hospice of Suffolk, Inc

  • Home Health Agency
  • Northport, NY
  • NPI 1770580516
  Care Compare affiliation
• Wellbound LLC

  dba Wellbound

  • Home Health Agency
  • Brooklyn, NY
  • NPI 1518305572
  Care Compare affiliation

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1912908484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KIM A VITACCO ANP-C",
            "address_2": "2 SHELTER HARBOR COURT",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922202",
            "telephone_number": "631-886-1668",
            "fax_number": "631-886-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KIM A VITACCO ANP-C",
            "address_2": "2 SHELTER HARBOR COURT",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922202",
            "telephone_number": "631-886-1668",
            "fax_number": "631-886-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITACCO",
        "first_name": "KIM",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "deactivation_date": "2022-04-28",
        "reactivation_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F303866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erik Michael Ulrich, LCSW
• Unbridled Aesthetics
• Sarah Verneuille, RN
• Dawn Verni
• Corinne Brooke Vidulich, M.D.
• Wading River Complete Dental Care PC
• Wading River Fire District
• Wading River Medical Care PC
• Wading River Pediatric Dentistry, PC
• Wading River Physical Therapy, PC

• Adult Health Nurse Practitioner in Wading River, NY
• Providers in Wading River, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.