Jacklyn Reyes Pancrudo, D.O.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

OS11255 Issued in FL

Practice address

11750 SW 40TH St
Miami, FL 33175-3530

Phone

(561) 997-0821

NPI assigned

Jul 24, 2009

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, TN, GA, NY, TX, VA, NV, DC, SC, KS, KY11 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 11

Specialty

Critical Care (Intensivists)

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Critical Care Physician of New York PCGroup PAC ID 4688825839, 43 clinicians

Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nyack Hospital Hospital, Nyack, NY, CCN 330104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations (25 of 32)

Interoperability endpoints

• Direct secure messaging: jacklyn.pancrudo@hca3.eclinicaldirectplus.com
• FHIR API: https://fhir-myrecord.cerner.com/r4/96fd612b-7f6c-4509-9e0b-25e1bdc16363/

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.

• Intensive Care Consortium Inc

  • Specialist
  • Aventura, FL
  • NPI 1629019062

  Critical Care Medicine, DC, GA, KY, SC, TN, VA

  Medicare reassignment Care Compare group NPD
• Critical Care Physician of New York PC

  • Critical Care Medicine (Internal Medicine) Physician
  • Newburgh, NY
  • NPI 1316293954
  Medicare reassignment Care Compare group NPD
• Cogent Healthcare of Jacksonville, LLC

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1124252333
  Medicare reassignment NPD
• Intensivist Medicine Services of FL, LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Tampa, FL
  • NPI 1235836388
  Medicare reassignment NPD
• Hospital Medicine Services of TX, PLLC

  • Hospitalist Physician
  • San Antonio, TX
  • NPI 1881392363
  Medicare reassignment NPD
• Intensive Care Consortium - Midwest, LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Wichita, KS
  • NPI 1275278574
  Medicare reassignment NPD
• Intensivist Medicine Services of TX, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Houston, TX
  • NPI 1790478444
  Medicare reassignment NPD
• Lone Star Intensivists at Gulf Coast, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Webster, TX
  • NPI 1528558236
  Medicare reassignment NPD
• Mercy Hospital of Buffalo

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1164464921
  Medicare reassignment NPD
• Sunrise Mountainview Multispecialty Clinics, LLC

  • Neurology Physician
  • Las Vegas, NV
  • NPI 1043402522

  Critical Care Medicine

  Medicare reassignment NPD
• Cogent Healthcare of Jacksonville, LLC

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1861150625
  NPD
• CHS Neuroscience Group

  • Neurology Physician
  • Buffalo, NY
  • NPI 1972883304

  Critical Care Medicine

  NPD

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

• Montefiore Nyack Hospital

  • General Acute Care Hospital
  • Nyack, NY
  • NPI 1104808062
  Care Compare affiliation

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1003046962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 NW CORPORATE BLVD",
            "address_2": "SUITE 270",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334318542",
            "telephone_number": "561-997-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11750 SW 40TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331753530",
            "telephone_number": "561-997-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCRUDO",
        "first_name": "JACKLYN",
        "middle_name": "REYES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-24",
        "last_updated": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "OS11255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JACKLYN.PANCRUDO@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "11750 SW 40th St",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331753530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cristobal Pancorbo Madrigal, CSA
• Dario Pancorbo, MD
• Elizabeth Laura Pancorbo, APRN
• Juan Pablo Pancorbo
• Flavia Pancorvo, LCSW
• Abhishek Pandey, MD
• Anita Pandey, DMD
• Sushmita Pandey
• Pandher Eye Care PLLC
• Dainelys Pando Mamposo

• Critical Care Medicine (Internal Medicine) Physician in Miami, FL
• Providers in Miami, FL by specialty
• Critical Care Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; 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.