NPIMap

Individual provider Active NPI

Stacey Digiacomo, P.A.

  • Physician Assistant
  • Port Jefferson Station, NY
National Provider Identifier
1023233103
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
007238 Issued in NY
Practice address
4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone
(631) 331-0500
Fax
(631) 331-1644
NPI assigned
Apr 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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 007238 NY Primary

Addresses

Primary practice location

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363

Mailing address

900 Merchants Concourse Ste 216
Westbury, NY 11590-5114
Phone (516) 226-8373

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
I20160318001864 NY Practitioner - Physician Assistant 5395067870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Square Care Medical Group LLPGroup PAC ID 7012938434, 70 clinicians

Practice addresses (Care Compare)

191 Herricks Rd
Garden City Park, NY 11040-5236
Phone (516) 742-2224

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone (631) 331-0500

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Merit-based Incentive Payment System (MIPS)

Final score
87.62 of 100Reported as group
Quality
88.76
Promoting interoperability
100
Improvement activities
40
Cost
69.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Jerry Ninia OB-GYN PLLC Past Accepting new patients
Jerry G Ninia MDPC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: stacey.digiacomo.1@15987.direct.athenahealth.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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1023233103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MERCHANTS CONCOURSE STE 216",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115905114",
            "telephone_number": "516-226-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763363",
            "telephone_number": "631-331-0500",
            "fax_number": "631-331-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIGIACOMO",
        "first_name": "STACEY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.