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MS. KAREN B CUMMINS NP
NPI 1295229615
Nurse Practitioner in York, ME

Active since June 19, 2018PECOS EnrolledAccepts Medicare Assignment
98.06/100
CMS Quality Rating
16 HOSPITAL DR, YORK, ME 03909(207) 351-3455(207) 354-1346 Get Directions Write a Review

NPPES record last updated: June 19, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ms. Karen B Cummins Np NPPES

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

MS. KAREN B CUMMINS NP (NPI 1295229615) is an individual nurse practitioner in York, Maine, licensed in Maine (CNP40273) and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS, is affiliated with York Hospital, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1295229615
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameMS. KAREN B CUMMINSCredential: NP
Location Address16 HOSPITAL DRYork, ME 03909-1011
Mailing Address15 Hospital DrYork, ME 03909-1099 · (207) 351-2478 · Fax (207) 351-2216
Phone(207) 351-3455
Fax(207) 354-1346
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateJune 19, 2018
✔ NPI 1295229615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in ME · CNP40273
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
16 HOSPITAL DR, York, ME 03909
Open in Google Maps ↗

Other Names 1

Former Name (1)Karen Barton

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from NH Healthy Families.Insurance ›

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

Ms. Karen B Cummins Np 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 ID7113941824
PECOS Enrollment IDI20180820000547
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 3

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.

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.
40 services30 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This 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.
20 services15 patients
Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101
This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.
11 services11 patients

Hospital Affiliations CMS Care Compare

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

York Hospital

Acute Care Hospitals · York, ME
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number200020
Location15 Hospital DriveYork, ME 03909 · York County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 03909 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
$86.72 typical visit price
range $56.28 – $169.96
Typical copayment $21.68 (range $14.07 – $42.49)
Most-billed visit code 99203
Established Patient
$99.18 typical visit price
range $18.22 – $138.92
Typical copayment $24.79 (range $4.55 – $34.73)
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.

98.06/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality86.13
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 17

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

DR. MARY C. VAUGHAN M.D.
Obstetrics & Gynecology
16 HOSPITAL DR, STE C.
YORK, ME 03909
York County (207) 351-3455
ORTHOPAEDIC ASSOCIATES OF YORK HOSPITAL
General Acute Care Hospital
16 HOSPITAL DR, STE A
YORK, ME 03909
York County (207) 363-3700
DARIN J MILLER M.D.
Surgery
16 HOSPITAL DR
YORK, ME 03909
York County (207) 351-3578
SEACOAST SURGERY
General Acute Care Hospital
16 HOSPITAL DR
YORK, ME 03909
York County (207) 351-3577
DR. KYLA J SCARPONI D.O.
Pediatrics
16 HOSPITAL DR, SUITE D
YORK, ME 03909
York County (207) 351-1710
EASTWEST NEUROLOGY, LLC
Psychiatry & Neurology (Neurology)
16 HOSPITAL DR
YORK, ME 03909
York County (207) 351-2696
SPORTSMEDICINE ATLANTIC ORTHOPAEDICS PA
Orthopaedic Surgery
16 HOSPITAL DR
YORK, ME 03909
York County (207) 363-3490
MARY LAMBRECHT
Registered Nurse
16 HOSPITAL DR
YORK, ME 03909
York County (207) 351-4321

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 Karen Cummins's NPI number?

The NPI number for Karen Cummins is 1295229615. It was assigned to this individual provider in the NPPES registry on June 19, 2018. The provider is also known as Karen Barton.

Where is Karen Cummins located?

Karen Cummins practices at 16 Hospital Dr, York, ME 03909. The listed phone number is (207) 351-3455.

What is Karen Cummins's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Karen Cummins enrolled in Medicare?

Yes. Karen Cummins 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.

What insurance does Karen Cummins accept?

Health plans from Ambetter from NH Healthy Families list Karen Cummins as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Karen Cummins affiliated with any hospitals?

According to CMS data, Karen Cummins is affiliated with York Hospital.

When was this NPI record last updated?

The NPPES record for Karen Cummins was last updated on June 19, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.