Individual provider Active NPI

Kevin Christopher Pachucki, RPA-C

  • Physician Assistant
  • Slingerlands, NY
National Provider Identifier
1922328236
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014000 Issued in NY
Practice address
1240 New Scotland Rd
Suite 203
Slingerlands, NY 12159-9222
Phone
(518) 439-2460
Fax
(518) 439-3025
NPI assigned
Jun 9, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

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 014000 NY Primary

Addresses

Primary practice location

1240 New Scotland Rd
Suite 203
Slingerlands, NY 12159-9222

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 2

IdentifierTypeStateIssuer
03250180MedicaidNY
100826000018OtherNYFIDELIS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100728000037 NY Practitioner - Physician Assistant 6901939909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

6 Wellness Way
Latham, NY 12110-2156
Phone (518) 782-3700

711 Troy Schenectady Rd
Latham, NY 12110-2461

Hospital & facility affiliations

  • St Peter'S Hospital Hospital, Albany, NY, CCN 330057

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014000NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Past Accepting new patients
St. Peter'S Health Partners Medical Associates, P.C. Physician Assistant Past Accepting new patients
Community Care Physicians, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kevinpachucki@ccp.allscriptsdirect.net

Organizations & group practices 4

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 1

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": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1922328236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 NEW SCOTLAND RD",
            "address_2": "SUITE 203",
            "city": "SLINGERLANDS",
            "state": "NY",
            "postal_code": "121599222",
            "telephone_number": "518-439-2460",
            "fax_number": "518-439-3025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHUCKI",
        "first_name": "KEVIN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-09",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03250180",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "100826000018",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slingerlands, NY

Sources for this page

Verify at the official NPI Registry.