Sydney L Kotredes, PNPC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

CNP171091 Issued in ME

Practice address

6 Telcom Dr
Bangor, ME 04401-3072

Phone

(207) 947-0147

Fax

(207) 990-3365

NPI assigned

Jul 20, 2015

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ME

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

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Penobscot Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
  • NPI 1427169010
  Medicare reassignment Care Compare group NPD
• Anchored Women'S Health, LLC

  • Clinic/Center
  • Ellsworth, ME
  • NPI 1053930966
  Medicare reassignment
• Penobscot Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
  • NPI 1083259410
  NPD
• Penobscot Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Winterport, ME
  • NPI 1093136871
  NPD
• Penobscot Community Health Center

  • Hearing and Speech Clinic/Center
  • Bangor, ME
  • NPI 1285685628
  NPD (past)

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1922483973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TELCOM DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013072",
            "telephone_number": "207-947-0147",
            "fax_number": "207-990-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTREDES",
        "first_name": "SYDNEY",
        "middle_name": "L",
        "credential": "PNPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "CNP171091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0501557",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103097936",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6180051-00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristina Kokotovich, LMT
• Rachel Eve Koransky-Matson, NP
• Guy Kositratna, M.D.
• Kelly Kossen
• Debra Bryant Kotredes, RPH
• Thomas Lewis Kotredes, RPH
• Michaela Koveleskie, PSYD
• Amaya Jenn Kozusko, MS, FNP-C
• Steven D Kozusko, MD, MED
• Gregory Paul Kramer, D.M.D.

• Pediatric Nurse Practitioner in Bangor, ME
• Providers in Bangor, ME by specialty
• Pediatric Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; 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.