Individual provider Active NPI

Randi Clarke, NP

  • Adult Health Nurse Practitioner
  • Woodbury, NY
National Provider Identifier
1003149618
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F3052261 Issued in NY
Practice address
43 Crossways Park Dr W
Woodbury, NY 11797-2002
Phone
(516) 938-3000
NPI assigned
Sep 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F3052261 NY Primary

Addresses

Primary practice location

43 Crossways Park Dr W
Woodbury, NY 11797-2002

Mailing address

43 Crossways Park Dr W
Woodbury, NY 11797-2002
Phone (516) 938-3000

Other practice location 1

300 Community Dr
Manhasset, NY 11030-3816
Phone (516) 410-4497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130619000564 NY Practitioner - Nurse Practitioner 0143469346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850
Phone (212) 434-6500

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F3052261NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Cardiovascular Disease CurrentSince May 1, 2018 Accepting new patients

Locations

39 Brentwood Rd
Ste 101
Bay Shore, NY 11706
Phone (631) 590-7400

402 Potter Blvd
Brightwaters, NY 11718
Phone (631) 689-1400

330 S Service Rd
Ste 121
Melville, NY 11747
Phone (516) 876-4100

100 E 77th St
#2
New York, NY 10075
Phone (212) 434-2460

300 Community Dr
Plandome, NY 11030

43 Crossways Park Dr W
Woodbury, NY 11797
Phone (516) 938-3000

Networks

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

Interoperability endpoints

  • Direct secure messaging: randiclarke@nslijmedgr.allscriptsdirect.net

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1003149618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 CROSSWAYS PARK DR W",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117972002",
            "telephone_number": "516-938-3000",
            "fax_number": "516-938-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 CROSSWAYS PARK DR W",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117972002",
            "telephone_number": "516-938-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Community Dr",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303816",
            "country_code": "US",
            "telephone_number": "516-410-4497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "RANDI",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F3052261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NY

Sources for this page

Verify at the official NPI Registry.