Kimberly Gurdy Innocent, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

021458 Issued in NY

Practice address

8268 164TH St
Jamaica, NY 11432-1121

Phone

(718) 883-3070

Fax

(718) 883-6115

NPI assigned

Oct 6, 2017

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, NJ2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Am PM Walk in Urgent Care ClinicGroup PAC ID 5092954602, 79 clinicians

Hicksville Family Medical Care PLLCGroup PAC ID 7416290564, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Englewood Hospital and Medical Center Hospital, Englewood, NJ, CCN 310045

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: kimberly.innocent@suwmc.eclinicaldirectplus.com

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.

• Hicksville Family Medical Care, PLLC

  • Family Medicine Physician
  • Mineola, NY
  • NPI 1770813792
  Medicare reassignment Care Compare group
• Am PM Walk in Urgent Care Clinic

  • Urgent Care Clinic/Center
  • Bergenfield, NJ
  • NPI 1073853859
  Medicare reassignment Care Compare group
• BP Immediate Medical Care, PC

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1205105004

  NJ

  Medicare reassignment
• Statcare Urgent & Walk in Medical Care PLLC

  • Urgent Care Clinic/Center
  • Mineola, NY
  • NPI 1336426667
  Medicare reassignment
• Citywide Urgent Care NJ LLC

  • Urgent Care Clinic/Center
  • Bloomfield, NJ
  • NPI 1689259822
  Medicare reassignment
• JPR Urgent Medical Care

  • Urgent Care Clinic/Center
  • Hicksville, NY
  • NPI 1114172848
  NPD (past)
• Pharma Holding Inc

  • Pharmacy
  • Brooklyn, NY
  • NPI 1396153680
  NPD (past)
• Rockland Medical Group, PLLC

  • Internal Medicine Physician
  • Garnerville, NY
  • NPI 1336172501
  NPD (past)
• Am PM Primary Care

  • Primary Care Clinic/Center
  • Bergenfield, NJ
  • NPI 1083045694
  NPD (past)

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

• Englewood Hospital and Medical Center

  • General Acute Care Hospital
  • Englewood, NJ
  • NPI 1083612881
  Care Compare affiliation

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507248000000",
    "number": "1922518786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3070",
            "fax_number": "718-883-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3070",
            "fax_number": "718-883-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNOCENT",
        "first_name": "KIMBERLY",
        "middle_name": "GURDY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-06",
        "last_updated": "2017-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alberto Inghirami, MD
• Steven R Inglis, MD
• Initiare Healthcare Services-Nurse Practitioner in Adult Health PLLC
• Inner Calm Wellness PC
• Innercalm Wellness
• Innovative Anesthesia PLLC
• Kentaro Inoue, R.PH
• Inspire Physical Therapy Wellness PLLC
• Institute for Childhood Education and Family Service
• Integrative Chiropractic and Physical Therapy of Jamaica Queens

• Physician Assistant in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.