NPIMap

Individual provider Active NPI

Jacqueline Sierra Coppola, DO

  • Cardiovascular Disease Physician
  • Schenectady, NY
National Provider Identifier
1013411388
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
312201 Issued in NY
Practice address
2546 Balltown Rd
Schenectady, NY 12309-1082
Phone
(518) 377-8184
NPI assigned
Mar 21, 2018
Last updated
Jun 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 499608657 NY
Cardiovascular Disease Physician 207RC0000X 312201 NY Primary

Addresses

Primary practice location

2546 Balltown Rd
Schenectady, NY 12309-1082

Mailing address

47 New Scotland Ave Dept of
Albany, NY 12208-3412
Phone (518) 262-5377

Other names 1

  • Jacqueline Sierra Coppola Other name

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
I20240723001082 NY Practitioner - Cardiovascular Disease (Cardiology) 6507101417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
New York College of Osteo Medicine of New York Institute of Technology, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2546 Balltown Rd
Suite 300
Schenectady, NY 12309-1079
Phone (518) 377-8184

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
312201NYMDCardiovascular Disease Physician
499608657NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
St. Peter's Health Partners Medical Associates, P.C. Cardiovascular Disease CurrentSince Aug 26, 2024 Accepting new patients
Community Care Physicians, PC CurrentSince Jun 23, 2024 Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. Past Accepting new patients

Locations

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

2546 Balltown Rd
Schenectady, NY 12309
Phone (518) 377-8184

2546 Balltown Rd
Ste 300
Schenectady, NY 12309
Phone (518) 377-8184

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

Interoperability endpoints

  • Direct secure messaging: jcoppola@caspc.medentdirect.com
  • Direct secure messaging: jkenitz26041@albanymed.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1013411388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 NEW SCOTLAND AVE DEPT OF",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083412",
            "telephone_number": "518-262-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2546 BALLTOWN RD",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123091082",
            "telephone_number": "518-377-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOLA",
        "first_name": "JACQUELINE",
        "middle_name": "SIERRA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "499608657",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "312201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "COPPOLA",
            "middle_name": "SIERRA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.