Active NPI
Ivelisse Guevara Reyes, FNP
- Family Nurse Practitioner
- Freeport, NY
National Provider Identifier
1114465499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 341114
- Practice address
- 55 N Main St
Freeport, NY 11520-2243 - Phone
- (516) 377-8014
- Fax
- (516) 977-9840
- NPI assigned
- Feb 7, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 341114 | NY | Primary |
Addresses
Primary practice location
55 N Main St
Freeport, NY 11520-2243
Mailing address
55 N Main St
Freeport, NY 11520-2243
Phone (516) 377-8014
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250313000095 | NY | Order and Referring Only - Nurse Practitioner | 9931484169 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
Interoperability endpoints
- ivf9004@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486425600000",
"number": "1114465499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 N MAIN ST",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115202243",
"telephone_number": "516-377-8014",
"fax_number": "516-977-9840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 N MAIN ST",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115202243",
"telephone_number": "516-377-8014",
"fax_number": "516-977-9840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUEVARA REYES",
"first_name": "IVELISSE",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-07",
"last_updated": "2017-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "341114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.