Individual provider Active NPI

Grace Lee, AGNP-C

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1154168979
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
311775 Issued in NY
Practice address
5030 Broadway
New York, NY 10034-1609
Phone
(718) 412-3445
NPI assigned
Jul 10, 2024
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 311775 NY Primary

Addresses

Primary practice location

5030 Broadway
New York, NY 10034-1609

Mailing address

5030 Broadway
New York, NY 10034-1609
Phone (718) 412-3445

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
I20240826001239 NY Practitioner - Nurse Practitioner 7416496260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
City University of New York School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gastrointestinal Care of Long Island PLLCGroup PAC ID 7517042211, 175 clinicians

Practice addresses (Care Compare)

187 Veterans Blvd
Massapequa, NY 11758-4982
Phone (516) 795-5523

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
311775NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Gastrointestinal Care of Long Island PLLC CurrentSince Jul 6, 2024 Accepting new patients
New York Gastroenterology and Hepatology PC CurrentSince Jul 6, 2024 Accepting new patients
Nyc Medical of Queens PC PastSince Mar 9, 2020 Accepting new patients

Locations

187 State Route 36
Ste 230
West Long Branch, NJ 07764
Phone (732) 222-3805

2027 Jerome Ave
Bronx, NY 10453
Phone (718) 294-1949

310 Grand Concourse
Ste L3
Bronx, NY 10451
Phone (718) 220-2433

7916 37th Ave
Jackson Heights, NY 11372
Phone (212) 927-0013

187 Veterans Blvd
Massapequa, NY 11758
Phone (516) 795-5523

187 Veterans Blvd
#13202
Massapequa, NY 11758
Phone (516) 795-5523

266 W 145th St
New York, NY 10039
Phone (212) 690-4002

5030 Broadway
New York, NY 10034
Phone (212) 567-9800

5030 Broadway
Ste 707
New York, NY 10034
Phone (718) 412-3445

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAEACD

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, 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": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1154168979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100341609",
            "telephone_number": "718-412-3445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100341609",
            "telephone_number": "718-412-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "GRACE",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "311775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.