Jessica A Calderon, PA-C
Individual provider Active NPI Physician Assistant · Bohemia, NY
NPI 1114628443 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1114628443
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 4875 Sunrise Hwy Ste 302
Bohemia, NY 11716-4630 - Phone
- (631) 343-4184
- NPI assigned
- Mar 14, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Shore-Lij Medical PC
Practice addresses (Care Compare)
300 Community Dr
Manhasset, NY 11030-3816
300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229
330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550
350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 79.77
- Promoting interoperability
- 88.77
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230927002908 | NY | Practitioner - Physician Assistant | 5294189072 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029889 | NY | MD | Physical Therapist |
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Shore - Lij Medical PC | Current |
Accepting new patients | |
| Blue Coast Medical Wellness, PLLC | Past |
Accepting new patients |
Locations
301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977
250 E Main St
Ste 1
Bay Shore, NY 11706
Phone (631) 390-7100
10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091
101 Saint Andrews Ln
Glen Cove, NY 11542
Phone (516) 674-7300
270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308
1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650
300 Community Dr
Plandome, NY 11030
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- jessicatrojan@nslijmedgr.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
4875 Sunrise Hwy Ste 302
Bohemia, NY 11716-4630
Mailing address
740 Main Rd
Riverhead, NY 11901-5723
Other practice location 1
740 Main Rd
Riverhead, NY 11901-5723
Phone (631) 343-4184
Other providers in Bohemia, NY
- Cheryl R Buscaglia
- Anthony Frank Buscaino
- Karly Mae Cairo
- Anthony Calabrese
- Renee Calabrese
- Jamie Campo
- Care & Comfort Associates, Inc
- Care and Comfort Associates, Inc.
- Elizabeth Carey
- Caring Hands
All providers in Bohemia, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.