NPIMap

Individual provider Active NPI

Jessica Lynn Blydenburgh, D.O.

  • Family Medicine Physician
  • Port Jefferson, NY
National Provider Identifier
1144548918
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
270049 Issued in NY
Practice address
125 Oakland Ave
Port Jefferson, NY 11777-2130
Phone
(631) 736-1311
Fax
(631) 736-1312
NPI assigned
May 4, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 270049 NY Primary

Addresses

Primary practice location

125 Oakland Ave
Port Jefferson, NY 11777-2130

Mailing address

211 Cassa Loop
Holtsville, NY 11742-2610
Phone (631) 786-4360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140204000799 NY Practitioner - Family Practice 2961631403 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Harbor View Medical Services PCGroup PAC ID 5092865873, shared by 3 NPIs, 58 clinicians

Practice addresses (Care Compare)

2500 Nesconset Hwy
Stony Brook, NY 11790-2555
Phone (631) 686-1414

Hospital & facility affiliations

  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • Constellation Home Care Home health agency, Syosset, NY, CCN 337447
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

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
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
270049NYMDFamily Medicine Physician

Practice roles (3 of 7)

OrganizationSpecialtyStatusNew patients
Harbor View Medical Services PC CurrentSince Sep 9, 2013 Accepting new patients
Harbor View Medical Services PC CurrentSince Sep 9, 2013 Accepting new patients
Harbor View Medical Services PC Current Accepting new patients

Locations

125 Oakland Ave
Ste 205
Port Jefferson, NY 11777
Phone (631) 686-2523

100 Highlands Blvd
#9
Port Jefferson, NY 11777
Phone (631) 686-7809

125 Oakland Ave
Port Jefferson, NY 11777
Phone (631) 476-2737

70 N Country Rd
Ste 101
Prt Jefferson, NY 11777
Phone (631) 473-0037

75 N Country Rd
Ste 201
Prt Jefferson, NY 11777
Phone (631) 686-2575

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

1 Jefferson Ferry Dr
South Setauket, NY 11720
Phone (631) 650-2600

2500 Nesconset Hwy
Bldg 2
Stony Brook, NY 11790
Phone (631) 444-2571

Networks

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

Interoperability endpoints

  • Direct secure messaging: jessica.blydenburgh.1@8551.direct.athenahealth.com

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 12

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": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1144548918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CASSA LOOP",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117422610",
            "telephone_number": "631-786-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 OAKLAND AVE",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772130",
            "telephone_number": "631-736-1311",
            "fax_number": "631-736-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYDENBURGH",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-04",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "270049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.