Individual provider Active NPI

Jaclyn McKinstry, M.D.

  • Pediatric Critical Care Medicine Physician
  • New York, NY
National Provider Identifier
1104052778
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
277037 Issued in NY
Practice address
403 E 34TH St
New York, NY 10016-4972
Phone
(212) 263-8475
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 241114 MA
Pediatric Cardiology Physician 2080P0202X 277037 NY
Pediatric Critical Care Medicine Physician 2080P0203X 277037 NY Primary

Addresses

Primary practice location

403 E 34TH St
New York, NY 10016-4972

Mailing address

1575 Tremont St
Apt #209
Roxbury Crossing, MA 02120-1677
Phone (856) 952-9206

Other practice location 1

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmckinstry268743@nyumc.direct-ci.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180831001564 NY Practitioner - Pediatric Medicine 7113178815 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
241114MAMDPediatrics Physician
277037NYMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Sep 1, 2018 Accepting new patients
New York University Pediatrics CurrentSince Sep 1, 2018 Accepting new patients
NYU Langone Hospitals Past Accepting new patients

Locations

403 E 34th St
New York, NY 10016
Phone (212) 263-8134

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

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

Interoperability endpoints

  • Direct secure messaging: jmckinstry268743@nyumc.direct-ci.com
  • Direct secure messaging: jmckinstry679318@nychhc.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1104052778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 TREMONT ST",
            "address_2": "APT #209",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021201677",
            "telephone_number": "856-952-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 E 34TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164972",
            "telephone_number": "212-263-8475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKINSTRY",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "241114",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NY",
            "license": "277037",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NY",
            "license": "277037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmckinstry268743@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "403 E 34th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100164972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.