Individual provider Active NPI

Genevieve Spota

  • Adult Health Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1003214628
Registry record updated Dec 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F307015-1 Issued in NY
Practice address
130 Rose Ave
Staten Island, NY 10306-2241
Phone
(718) 980-1553
NPI assigned
Dec 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2014

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 F307015-1 NY Primary

Addresses

Primary practice location

130 Rose Ave
Staten Island, NY 10306-2241

Mailing address

130 Rose Ave
Staten Island, NY 10306-2241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, ME3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20190716002817 NY Practitioner - Nurse Practitioner 2860727641
I20210907003598 NJ Practitioner - Nurse Practitioner 2860727641 Reassigns benefits to 1 organization
I20260331000965 ME Practitioner - Nurse Practitioner 2860727641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12900 Park Plaza Dr
Suite 150
Cerritos, CA 90703-9329

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F307015-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care NP in Family Health and Adult Health of New York PLLC PastSince Jan 1, 2016 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gspota21187@carelonhealth.direct-ci.com

Organizations & group practices 2

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": "1418428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418428800000",
    "number": "1003214628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 ROSE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 ROSE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062241",
            "telephone_number": "718-980-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPOTA",
        "first_name": "GENEVIEVE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-13",
        "last_updated": "2014-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307015-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.