Individual provider Active NPI

Karen L Olivieri, P.A.

  • Physician Assistant
  • Northport, NY
National Provider Identifier
1013914514
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008469 Issued in NY
Practice address
325 Main St
Northport, NY 11768-1730
Phone
(631) 261-4445
Fax
(631) 261-3710
NPI assigned
Jun 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 008469 NY Primary

Addresses

Primary practice location

325 Main St
Northport, NY 11768-1730

Mailing address

325 Main St
Northport, NY 11768-1730
Phone (631) 261-4445

Other identifiers 3

IdentifierTypeStateIssuer
4F9081OtherNYMEDICARE LEGACY
4F9081OtherNYBLUE CROSS/BLUE SHIELD
02383080MedicaidNY

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
I20081201000299 NY Practitioner - Physician Assistant 1951461540 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rajeswara Rao Patcha, MD,PCGroup PAC ID 9638068323, 8 clinicians
North Shore Lij Medical Group at North Nassau, PCGroup PAC ID 7618154550, 36 clinicians

Practice addresses (Care Compare)

172 E Main St
Huntington, NY 11743-2948
Phone (631) 385-0022

325 Main St
Northport, NY 11768-1790
Phone (631) 385-0022

70 Glen St
Suite 200
Glen Cove, NY 11542-2854
Phone (516) 484-7893

Hospital & facility affiliations

  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • VNS & Hospice of Suffolk Inc Chha Home health agency, Northport, NY, CCN 337014
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
008469NYMDMental Health Counselor

Networks

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

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.

Hospital & facility affiliations 4

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303862400000",
    "number": "1013914514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681730",
            "telephone_number": "631-261-4445",
            "fax_number": "631-261-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681730",
            "telephone_number": "631-261-4445",
            "fax_number": "631-261-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVIERI",
        "first_name": "KAREN",
        "middle_name": "L",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "4F9081",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "4F9081",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02383080",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, NY

Sources for this page

Verify at the official NPI Registry.