Individual provider Active NPI

Ana D Forman, FNP

  • Family Nurse Practitioner
  • East Meadow, NY
National Provider Identifier
1114456795
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F340507-1 Issued in NY
Practice address
1530 Front St
East Meadow, NY 11554-2265
Phone
(516) 324-7500
NPI assigned
Jun 7, 2017
Last updated
Mar 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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 F340507-1 NY Primary

Addresses

Primary practice location

1530 Front St
East Meadow, NY 11554-2265

Mailing address

3268 45TH St Apt 1R
Astoria, NY 11103-1913
Phone (917) 732-6041

Other practice location 1

525 E 68th St
New York, NY 10065-4870
Phone (212) 746-2260

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aforman482379@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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191108002276 NY Practitioner - Nurse Practitioner 5395177521 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

1530 Front St
East Meadow, NY 11554-2265
Phone (516) 324-7500

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
340507NYMDOphthalmology Physician
F340507-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jan 3, 2022 Accepting new patients
Weill Medical College of Cornell Current Accepting new patients
Weill Medical College of Cornell CurrentSince Sep 25, 2019 Accepting new patients
New York University CurrentSince Jan 3, 2022 Accepting new patients
Weill Medical College of Cornell CurrentSince Sep 25, 2019 Accepting new patients

Locations

1530 Front St
East Meadow, NY 11554
Phone (516) 324-7500

520 E 70th St
#651
New York, NY 10021
Phone (212) 746-2385

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

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

Networks

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

Interoperability endpoints

  • Direct secure messaging: aforman482379@nyumc.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1114456795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3268 45TH ST APT 1R",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111031913",
            "telephone_number": "917-732-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 FRONT ST",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115542265",
            "telephone_number": "516-324-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E 68th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100654870",
            "country_code": "US",
            "telephone_number": "212-746-2260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "ANA",
        "middle_name": "D",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-07",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F340507-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aforman482379@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "1530 Front St",
            "city": "East Meadow",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115542265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Meadow, NY

Sources for this page

Verify at the official NPI Registry.