Individual provider Active NPI

Grace Nabila Pena Fatule, M.D.

  • Internal Medicine Physician
  • Jamaica, NY
National Provider Identifier
1124482484
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
307883-01 Issued in NY
Practice address
8900 Van Wyck Expy
Jamaica, NY 11418-2832
Phone
(210) 206-6000
NPI assigned
Apr 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY
Internal Medicine Physician 207R00000X 307883-01 NY Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 307883-01 NY
Pulmonary Disease Physician 207RP1001X 307883-01 NY

Addresses

Primary practice location

8900 Van Wyck Expy
Jamaica, NY 11418-2832

Mailing address

8900 Van Wyck Expy
Jamaica, NY 11418-2832
Phone (718) 206-6000

Other names 1

  • Grace Nabila Martinez Pena Former name

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
I20210125001901 NY Practitioner - Internal Medicine 0749525939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamaica HospitalGroup PAC ID 2264324334, 252 clinicians
TJH Medical Services PCGroup PAC ID 8527960533, 215 clinicians

Practice addresses (Care Compare)

8900 Van Wyck Expy
Jamaica, NY 11418-2832
Phone (718) 206-6601

Hospital & facility affiliations

  • Jamaica Hospital Medical Center Hospital, Jamaica, NY, CCN 330014

Merit-based Incentive Payment System (MIPS)

Final score
85.41 of 100Reported as group
Quality
64.77
Promoting interoperability
79
Improvement activities
40
Cost
70.76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
307883-01NYMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
TJH Medical Services, P.C. Internal Medicine CurrentSince Jan 1, 2021 Accepting new patients
Jamaica Hospital CurrentSince Aug 24, 2022 Accepting new patients
Jamaica Hospital CurrentSince Aug 24, 2022 Accepting new patients
Jamaica Hospital Medical Center Past Accepting new patients
Jamaica Hospital Past Accepting new patients

Locations

11940 Metropolitan Ave
Kew Gardens, NY 11415
Phone (718) 849-0839

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

8900 Van Wyck Expy
Richmond Hill, NY 11418
Phone (718) 206-6088

Networks

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

Interoperability endpoints

  • Direct secure messaging: gmartinezpena46337@direct.medisys.org

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 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": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1124482484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8900 VAN WYCK EXPY",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114182832",
            "telephone_number": "718-206-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 VAN WYCK EXPY",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114182832",
            "telephone_number": "210-206-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA FATULE",
        "first_name": "GRACE",
        "middle_name": "NABILA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "307883-01",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "307883-01",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "307883-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "MARTINEZ PENA",
            "middle_name": "NABILA",
            "credential": "M. D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.