NPIMap

Individual provider Active NPI

Manjju Agnes Pulickal, CRNA

  • Certified Registered Nurse Anesthetist
  • Mt. Kisco, NY
National Provider Identifier
1972801629
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
597810 Issued in NY
Practice address
344 Main St
Suite 104
Mt. Kisco, NY 10549
Phone
(914) 242-3652
Fax
(914) 244-8983
NPI assigned
Mar 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 26NJ00321900 NJ
Certified Registered Nurse Anesthetist 367500000X 597810 NY Primary

Addresses

Primary practice location

344 Main St
Suite 104
Mt. Kisco, NY 10549

Mailing address

PO Box 551420
Fort Lauderdale, FL 33355-1420
Phone (800) 243-3839

Other names 1

  • Manjju Agnes Thadathil Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111206000271 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709051584 Reassigns benefits to 1 organization
I20131009001804 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709051584 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Anesthesia Associates of Morristown PAGroup PAC ID 7315906591, 168 clinicians
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians
North Shore - Lij Anesthesiology, PCGroup PAC ID 1153602453, 990 clinicians

Practice addresses (Care Compare)

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5539

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

111 Madison Ave
Morristown, NJ 07960-6097
Phone (973) 971-6900

61 Emerald PL
Rock Hill, NY 12775-6049
Phone (914) 666-8866

Hospital & facility affiliations

  • Morristown Medical Center Hospital, Morristown, NJ, CCN 310015
  • St John'S Riverside Hospital Hospital, Yonkers, NY, CCN 330208
  • Phelps Hospital Hospital, Sleepy Hollow, NY, CCN 330261
  • Northern Westchester Hospital Hospital, Mount Kisco, NY, CCN 330162

Merit-based Incentive Payment System (MIPS)

Final score
80.76 of 100Reported as group
Quality
78.69
Improvement activities
40
Cost
74.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles (2 of 6)

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Morristown PA CurrentSince Oct 17, 2011 Accepting new patients
North Shore-Lij Medical PC CurrentSince Mar 1, 2020 Accepting new patients

Locations

111 Madison Ave
Morristown, NJ 07960
Phone (201) 943-5991

195 E Main St
Huntington, NY 11743
Phone (631) 385-8677

300 Community Dr
Plandome, NY 11030

Networks

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

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 5

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": "1299196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1972801629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "855-851-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 MAIN ST",
            "address_2": "SUITE 104",
            "city": "MT. KISCO",
            "state": "NY",
            "postal_code": "10549",
            "telephone_number": "914-242-3652",
            "fax_number": "914-244-8983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULICKAL",
        "first_name": "MANJJU",
        "middle_name": "AGNES",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-04",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ00321900",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "597810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANJJU",
            "last_name": "THADATHIL",
            "middle_name": "AGNES",
            "credential": "CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mt. Kisco, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.