Individual provider Active NPI

Grace Couch, FNP

  • Family Nurse Practitioner
  • Great Neck, NY
National Provider Identifier
1073296224
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F352163-01 Issued in NY
Practice address
865 Northern Blvd
Great Neck, NY 11021-5335
Phone
(516) 622-5114
NPI assigned
Aug 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F352163-01 NY Primary

Addresses

Primary practice location

865 Northern Blvd
Great Neck, NY 11021-5335

Mailing address

24079 67TH Ave
Douglaston, NY 11362-1926
Phone (718) 869-4356

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
I20240517003362 NY Practitioner - Nurse Practitioner 1153762380 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F352163-01NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Apr 8, 2024 Accepting new patients
North Shore-Lij Medical PC CurrentSince Apr 8, 2024 Accepting new patients

Locations

865 Northern Blvd
Great Neck, NY 11021
Phone (516) 622-5000

865 Northern Blvd
Ste 202
Great Neck, NY 11021
Phone (516) 622-5100

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

300 Community Dr
Plandome, NY 11030

Networks

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

Interoperability endpoints

  • Direct secure messaging: gracecouch@nslijmedgr.allscriptsdirect.net

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": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1073296224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24079 67TH AVE",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113621926",
            "telephone_number": "718-869-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215335",
            "telephone_number": "516-622-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUCH",
        "first_name": "GRACE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F352163-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.