Individual provider Active NPI

Nicholas Ruggiero, PA-C

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1104448489
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
025948 Issued in NY
Practice address
136 Brook Ave
Staten Island, NY 10306-4420
Phone
(718) 619-6124
NPI assigned
May 10, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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 025948 NY Primary

Addresses

Primary practice location

136 Brook Ave
Staten Island, NY 10306-4420

Mailing address

136 Brook Ave
Staten Island, NY 10306-4420
Phone (718) 619-6124

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
I20210929000120 NY Practitioner - Physician Assistant 4284031519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

3333 Hylan Blvd
Staten Island, NY 10306-3608
Phone (516) 302-8180

36 Lincoln Ave
Rockville Centre, NY 11570-5768
Phone (516) 536-2800

Hospital & facility affiliations

  • Staten Island University Hospital Hospital, Staten Island, NY, CCN 330160

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
025948NYMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC Physician Assistant CurrentSince Jul 2, 2021 Accepting new patients
True North Medical Group PC CurrentSince Jul 2, 2021 Accepting new patients
True North Medical Group PC Past Accepting new patients

Locations

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

88 Old Town Rd
Staten Island, NY 10304
Phone (718) 979-4508

25 Fanning St
Staten Island, NY 10314
Phone (347) 671-8399

140 Meisner Ave
Staten Island, NY 10306
Phone (718) 979-1800

3333 Hylan Blvd
Staten Island, NY 10306
Phone (718) 667-3333

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EGCGAA/Endpoint/EGCGAA
  • Direct secure messaging: nicholasruggiero@nslijmedgr.allscriptsdirect.net

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 1

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": "1589068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1104448489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 BROOK AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064420",
            "telephone_number": "718-619-6124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 BROOK AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064420",
            "telephone_number": "718-619-6124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUGGIERO",
        "first_name": "NICHOLAS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-10",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.