1. Home
  2. Directory
  3. New York
  4. Port Jefferson
  5. Nurse Practitioner
  6. NPI Profile

KENNETH WILLIAM NISSEN ANP
NPI 1043659980
Nurse Practitioner - Adult Health in Port Jefferson, NY

Active since June 24, 2013PECOS EnrolledAccepts Medicare Assignment
91.25/100
CMS Quality Rating
75 N COUNTRY RD, PORT JEFFERSON, NY 11777(631) 476-2786 Get Directions Write a Review

NPPES record last updated: June 24, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenneth William Nissen Anp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH WILLIAM NISSEN ANP (NPI 1043659980) is an individual adult health provider in Port Jefferson, New York, licensed in New York (306258) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS, is affiliated with John T Mather Memorial Hospital Of Port Jefferson, and is a graduate of State University Of New York At Stony Brook, School Of Medicine (2012).

NPPES Registry Identity

NPI1043659980
Entity TypeIndividualMale
Primary Taxonomy363LA2200X
Provider Legal NameKENNETH WILLIAM NISSENCredential: ANP
Location Address75 N COUNTRY RDPort Jefferson, NY 11777-2119
Mailing Address25 Wiltshire DrCommack, NY 11725-3330 · (516) 521-0456
Phone(631) 476-2786
Sole ProprietorYes
Medical School CMSState University Of New York At Stony Brook, School Of MedicineGraduated 2012
Enumeration DateJune 24, 2013
✔ NPI 1043659980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
License✔ Licensed in NY · 306258
75 N COUNTRY RD, Port Jefferson, NY 11777
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kenneth William Nissen Anp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264667633
PECOS Enrollment IDI20131022000044
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg J7328
Gelsyn-3 is a treatment involving injections of a substance called hyaluronan into the joint space. Hyaluronan is naturally present in healthy joint fluid, aiding in lubrication and shock absorption. This treatment helps relieve joint pain, often in conditions like osteoarthritis.
71,910 services136 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
380 services154 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This 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.
150 services116 patients
Replacement of knee joint, both sides of knee 27447
A bilateral knee joint replacement is a procedure where the damaged parts of both your knee joints are replaced with artificial parts. It aims to relieve pain and improve mobility. The process involves a surgical operation under anesthesia.
75 services75 patients
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg J0702
This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.
53 services25 patients
X-ray of knee, 3 views 73562
An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.
39 services37 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

John T Mather Memorial Hospital Of Port Jefferson

Acute Care Hospitals · Port Jefferson, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330185
Location75 North Country RoadPort Jefferson, NY 11777 · Suffolk County
Emergency services

St Charles Hospital

Acute Care Hospitals · Port Jefferson, NY
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number330246
Location200 Belle Terre RoadPort Jefferson, NY 11777 · Suffolk County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11777 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$117.62 typical visit price
range $21.66 – $164.45
Typical copayment $29.40 (range $5.41 – $41.11)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.25/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality74.92
Promoting Interoperability91.67
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTINA CATHERINE MELLONE DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
AAKAASH VARMA MD
Dermatology
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
KRISELA VOJNIKU MD
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
LORETTA DIDWELL
Physician Assistant
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
RAYMOND WONG
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-7654
KATLYN ANN CONVILLE ANTHONY NP
Nurse Practitioner (Family)
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2565
SHEHNAZ WASIM MD
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-1443
JULIA KOROBENKO DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Nissen's NPI number?

The NPI number for Kenneth Nissen is 1043659980. It was assigned to this individual provider in the NPPES registry on June 24, 2013.

Where is Kenneth Nissen located?

Kenneth Nissen practices at 75 N Country Rd, Port Jefferson, NY 11777. The listed phone number is (631) 476-2786.

What is Kenneth Nissen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Kenneth Nissen enrolled in Medicare?

Yes. Kenneth Nissen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Kenneth Nissen affiliated with any hospitals?

According to CMS data, Kenneth Nissen is affiliated with John T Mather Memorial Hospital Of Port Jefferson and St Charles Hospital.

When was this NPI record last updated?

The NPPES record for Kenneth Nissen was last updated on June 24, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.