NPIMap

Individual provider Active NPI

Andrea Martinez Villalobos, RPA-C

  • Physician Assistant
  • Central Islip, NY
National Provider Identifier
1003280041
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018884 Issued in NY
Practice address
159 Carleton Ave
Central Islip, NY 11722-4172
Phone
(631) 650-2510
Fax
(631) 650-0497
NPI assigned
Nov 13, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 018884 NY
Physician Assistant 363A00000X 018884 NY Primary

Addresses

Primary practice location

159 Carleton Ave
Central Islip, NY 11722-4172

Mailing address

9033 Elmhurst Ave
Jackson Heights, NY 11372-7935
Phone (718) 457-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190403000960 NY Practitioner - Physician Assistant 6709155294 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Long Island Select Healthcare, IncGroup PAC ID 5991086225, 29 clinicians

Practice addresses (Care Compare)

120 Plant Ave
Hauppauge, NY 11788-3827
Phone (631) 650-2510

159 Carleton Ave
Central Islip, NY 11722-4172
Phone (631) 650-2510

Hospital & facility affiliations

  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Long Island Select Healthcare, Inc. CurrentSince Feb 18, 2019 Accepting new patients

Locations

159 Carleton Ave
Central Islip, NY 11722
Phone (631) 439-4300

120 Plant Ave
Hauppauge, NY 11788
Phone (631) 273-1300

883 E Main St
Riverhead, NY 11901
Phone (631) 284-5500

Networks

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

Interoperability endpoints

  • Direct secure messaging: andrea.martinezvillalobos@queensmedical.ehi.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CCJFAD/Endpoint/CCJFAD

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1003280041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9033 ELMHURST AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727935",
            "telephone_number": "718-457-7000",
            "fax_number": "718-899-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224172",
            "telephone_number": "631-650-2510",
            "fax_number": "631-650-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ VILLALOBOS",
        "first_name": "ANDREA",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-13",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "018884",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Islip, NY

Sources for this page

Verify at the official NPI Registry.