MS. KRISTIN B SMUCKER P.A.
NPI 1255367074
Physician Assistant in Bridgeport, WV
NPI Status: Active since June 23, 2006
Contact Information
120 MEDICAL PARK DR
SUITE 200
BRIDGEPORT, WV
ZIP 26330
Phone: (304) 624-7200
Fax: (304) 624-0026
- Individual
- Female
- Years of Experience 26
- Physician Assistant
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About KRISTIN SMUCKER
This page provides the complete NPI Profile along with additional information for Kristin Smucker, a primary care provider established in Bridgeport, West Virginia with a medical specialization in Physician Assistant and more than 26 years of experience. The healthcare provider is registered in the NPI registry with number 1255367074 assigned on June 2006. The practitioner's primary taxonomy code is 363A00000X with license number 00806 (WV). The provider is registered as an individual and her NPI record was last updated 10 years ago.
- NPI
- 1255367074
- Provider Name
- MS. KRISTIN B SMUCKER P.A.
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 120 MEDICAL PARK DR SUITE 200 BRIDGEPORT, WV 26330
- Location Phone
- (304) 624-7200
- Location Fax
- (304) 624-0026
- Mailing Address
- 125 N 6TH ST CLARKSBURG, WV 26301
- Mailing Phone
- (304) 624-7200
- Mailing Fax
- (304) 624-0026
- Medical School Name
- OTHER
- Graduation Year
- 2000
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-23-2006
- Last Update Date
- 01-23-2015
- Code Navigator
A primary care provider (PCP) like Kristin Smucker sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 00806
- License State
- WV
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze First 7500 $25 Generic Drugs - HMO
- Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Gold 1500 $15 Generic Drugs - HMO
- Gold 1500 $15 Generic Drugs Adult Vision & Fitness - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Low Deductible Silver 4500 $3 Generic Drugs - HMO
- Low Deductible Silver 4500 $3 Generic Drugs Adult Vision & Fitness - HMO
- Low Premium Silver 6000 $3 Generic Drugs - HMO
- Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness - HMO
- Platinum Zero $5 Generic Drugs - HMO
- Platinum Zero $5 Generic Drugs Adult Vision & Fitness - HMO
- Silver 5000 $20 Generic Drugs - HMO
- Silver 5000 $20 Generic Drugs Adult Vision & Fitness - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| P61030 | MEDICARE UPIN (02) | WV | |
| PA18772 | MEDICARE PIN (08) | WV |
Medicare Participation & PECOS Enrollment Status
Kristin Smucker is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Kristin Smucker is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 4688565187
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20040323001666
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Biopsy of related skin growth, each additional growth
Biopsy of related skin growth, first growth
Destruction of precancer skin growth, 1 growth
Destruction of precancer skin growth, 2-14 growths
Destruction of skin growth, 1-14 growths
Destruction of skin growth, 15 or more growths
Established patient office or other outpatient visit, 10-19 minutes
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
New patient office or other outpatient visit, 15-29 minutes
New patient office or other outpatient visit, 30-44 minutes
Punch biopsy, first skin growth
A biopsy of related skin growth is a procedure where a small piece of skin growth is removed for testing. If additional growths are identified, they may also be biopsied. This helps in diagnosing skin conditions and planning appropriate treatment.
This service was performed 33 times for 24 patientsA biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.
This service was performed 95 times for 90 patients"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.
This service was performed 91 times for 77 patientsThis procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.
This service was performed 333 times for 47 patients"Destruction of skin growth" refers to a procedure where 1-14 abnormal skin growths are removed. This is done using methods such as freezing, burning, or laser therapy. It helps prevent the growth from causing discomfort or turning into a more serious condition.
This service was performed 95 times for 82 patients"Destruction of skin growth" refers to a procedure where unwanted skin growths, such as warts or moles, are removed. In this case, 15 or more growths are treated. Techniques may include freezing, burning, or laser therapy. It's a safe, quick process to improve skin health.
This service was performed 19 times for 17 patientsThis is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
This service was performed 41 times for 38 patientsThis is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
This service was performed 249 times for 203 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 25 times for 23 patientsThis service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.
This service was performed 20 times for 20 patientsThis service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
This service was performed 66 times for 66 patientsA punch biopsy is a procedure where a small, circular tool is used to remove a sample of skin tissue. This is usually done to test a skin growth for potential issues. You may feel a pinch, but discomfort is minimal. The area heals quickly.
This service was performed 12 times for 12 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $20.87 for a new patient copayment and $16.71 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 26330 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $83.49
- Minimum New Patient Price $53.2
- Maximum New Patient Price $164.59
- Average New Patient Copayment $20.87
- Minimum New Patient Copayment $13.3
- Maximum New Patient Copayment $41.14
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $66.84
- Minimum Established Patient Price $16.47
- Maximum Established Patient Price $133.29
- Average Established Patient Copayment $16.71
- Minimum Established Patient Copayment $4.11
- Maximum Established Patient Copayment $33.32
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Biopsy Follow-Up | 21% | 195 |
| Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician | ||
| Collection and follow-up on patient experience and satisfaction data on beneficiary engagement | Yes | N/A |
| Collection and follow-up on patient experience and satisfaction data on beneficiary engagement, including development of improvement plan. | ||
| Documentation of Current Medications in the Medical Record | 98% | 2677 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| Engagement of New Medicaid Patients and Follow-up | Yes | N/A |
| Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare. A timely manner is defined as within 10 business days for this activity. | ||
| e-Prescribing | 85% | 1000 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Medication Reconciliation | 90% | 264 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 47% | 898 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 39% | 104 |
| Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user | ||
| Provide Patient Access | 59% | 898 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | Yes | N/A |
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | ||
| Secure Messaging | 6% | 898 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Specialized Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI. | ||
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Kristin Smucker is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| UNITED HOSPITAL CENTER, INC | 327 MEDICAL PARK DRIVE BRIDGEPORT, WV 26330 | (681) 342-1000 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 5 | 5 | 3 | 6 | 7 | 0 | 7 | 4 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 10 | 5 | 6 | 6 | 14 | 0 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 0 + 5 + 6 + 6 + 1 + 4 + 0 + 1 + 4 + 24 = 56 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 56 = 4 | 4 | ||||||||
The NPI number 1255367074 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 18 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1265469472 | DR. CREEL S CORNWELL M.D. Individual | Internal Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1144659574 | MELISSA MINIGH Individual | Pharmacist | 120 MEDICAL PARK DR SUITE 102 BRIDGEPORT, WV 26330 (304) 423-5200 |
| 1962520387 | DR. LORI MICHELE ANGOTTI O.D. Individual | Optometrist | 120 MEDICAL PARK DR SUITE 104 BRIDGEPORT, WV 26330 (304) 842-4000 |
| 1871998047 | ANGOTTI FAMILY EYECARE PLLC Organization | Optometrist | 120 MEDICAL PARK DR SUITE 104 BRIDGEPORT, WV 26330 (304) 842-4000 |
| 1649212903 | DR. JEFFREY A DODSON M.D. Individual | Dermatology | 120 MEDICAL PARK DR SUITE 200 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1215973995 | DR. CHARLES BRADLEY FRANZ M.D. Individual | Dermatology | 120 MEDICAL PARK DR SUITE 200 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1053553131 | SHARIFEH FARASAT MD Individual | Dermatology | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1114128634 | DR. FRANK THOMAS ANGOTTI III M.D. Individual | Psychiatry & Neurology (Child & Adolescent Psychiatry) | 120 MEDICAL PARK DR UNITED SUMMIT CENTER - FRANK ANGOTTI MD BRIDGEPORT, WV 26330 (304) 848-2000 |
| 1619067873 | ANTHONY CATANIA JR. DPM Individual | Podiatrist | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1992155097 | UNITED HOSPITAL CENTER, INC. Organization | Family Medicine | 120 MEDICAL PARK DR STE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1891892097 | MOUNTAIN STATE MEDICAL SPECIALTIES, PLLC Organization | Dermatology | 120 MEDICAL PARK DR SUITE 200 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1760435838 | KELLY RAPHAEL NELSON MD Individual | Family Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1043262942 | FRANCES BLAKE MURRAY MD Individual | Family Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1073500773 | ERIN COLLEEN HAWKINS FNP-BC Individual | Nurse Practitioner (Family) | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1134225832 | JAMES E MALONE D.O. Individual | Family Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1205933538 | HAELEY E HARMAN D.O. Individual | Family Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1598822207 | DR. STEPHEN FULLER FRYER D.O. Individual | Family Medicine | 120 MEDICAL PARK DR SUITE 300 BRIDGEPORT, WV 26330 (304) 624-7200 |
| 1548371503 | MS. GEORGIA DAWN DANIEL APRN Individual | Nurse Practitioner (Family) | 120 MEDICAL PARK DR SUITE 200 BRIDGEPORT, WV 26330 (304) 624-7200 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1255367074, enumerated in the NPI registry as an "individual" on June 23, 2006
The provider is located at 120 Medical Park Dr Suite 200 Bridgeport, Wv 26330 and the phone number is (304) 624-7200
The provider's speciality is Physician Assistant with taxonomy code 363A00000X
The provider has more than 26 years of experience.
The provider might be accepting Accepts: CareSource, Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $83.49 with an average copayment of $20.87 for new patient appointments. Established patients should expect a typical charge of $66.84 and an average copayment of 16.71. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Biopsy of related skin growth, each additional growth, Biopsy of related skin growth, first growth, Destruction of precancer skin growth, 1 growth, Destruction of precancer skin growth, 2-14 growths, Destruction of skin growth, 1-14 growths, Destruction of skin growth, 15 or more growths, Established patient office or other outpatient visit, 10-19 minutes, Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, New patient office or other outpatient visit, 15-29 minutes, New patient office or other outpatient visit, 30-44 minutes and Punch biopsy, first skin growth.
The practitioner is affiliated to the following hospital(s): UNITED HOSPITAL CENTER, INC. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on June 23, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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