Individual provider Active NPI

Stefania Anne Vendome, PA-C

  • Physician Assistant
  • Astoria, NY
National Provider Identifier
1154843076
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
020963 Issued in NY
Practice address
23-38 28TH Street
Astoria, NY 11105
Phone
(347) 387-3684
NPI assigned
Jul 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 020963 NY Primary

Addresses

Primary practice location

23-38 28TH Street
Astoria, NY 11105

Mailing address

2338 28TH St
Astoria, NY 11105-3198
Phone (347) 387-3684

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
I20171120003338 NY Practitioner - Physician Assistant 4385901735 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

1332 Peninsula Blvd
Hewlett, NY 11557-1226
Phone (516) 531-6130

3631 Hempstead Tpke
63A
Levittown, NY 11756-1315
Phone (516) 537-9063

377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061

4119 Bell Blvd
Bayside, NY 11361-2858
Phone (929) 373-4480

5828 99TH St
Corona, NY 11368-4306
Phone (718) 502-9867

5828 99TH St Corona
Corona, NY 11368-4306
Phone (718) 502-9867

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
020963NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
PM Pediatrics of Mamaroneck Past Accepting new patients
PM Pediatrics PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: stefania.vendome@ghuc.eclinicaldirectplus.com

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154843076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2338 28TH ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111053198",
            "telephone_number": "347-387-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23-38 28TH STREET",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "11105",
            "telephone_number": "347-387-3684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENDOME",
        "first_name": "STEFANIA",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

Verify at the official NPI Registry.