Individual provider Active NPI

Jacqueline Polito

  • Adult Health Nurse Practitioner
  • New Hyde Park, NY
National Provider Identifier
1154865335
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
308016 Issued in NY
Practice address
1991 Marcus Ave, 2ND Floor
New Hyde Park, NY 11042-2057
Phone
(516) 354-1600
Fax
(516) 941-4677
NPI assigned
Dec 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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 308016 NY Primary

Addresses

Primary practice location

1991 Marcus Ave, 2ND Floor
New Hyde Park, NY 11042-2057

Mailing address

55 Water Street
2ND Floor Cred Dept
New York, NY 10041-0004
Phone (646) 680-2888

Other practice location 1

6010 Bay Pkwy
Suite 901
Brooklyn, NY 11204-6079
Phone (718) 238-2100

Other practice location 2

96-10 Metropolitan Ave
Forest Hills, NY 11375-6625
Phone (718) 459-0400

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
I20161229000157 NY Practitioner - Nurse Practitioner 3375824600 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347

1000 N Village Ave
Rockville Center, NY 11570-1000

2000 N Village Ave
Rockville Centre, NY 11570-1001

Hospital & facility affiliations

  • Mercy Medical Center Hospital, Rockville Centre, NY, CCN 330259

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC CurrentSince Jul 1, 2018 Accepting new patients
Advantagecare Physicians PC CurrentSince Jul 1, 2018 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
CHS Physician Partners, PC CurrentSince Aug 1, 2022 Accepting new patients
CHS Physician Partners, P.C CurrentSince Aug 1, 2022 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

9610 Metropolitan Ave
Forest Hills, NY 11375
Phone (718) 459-0400

1991 Marcus Ave
Fl 2
New Hyde Park, NY 11042
Phone (516) 354-1600

55 Water St
Fl 2
New York, NY 10041

1991 Marcus Ave
#2
North New Hyde Park, NY 11042
Phone (516) 354-1600

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

2000 N Village Ave
Ste 108
Rockville Ctr, NY 11570
Phone (516) 678-1444

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

Networks

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

Interoperability endpoints

  • Direct secure messaging: jpolito143682@direct-chsli.net
  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4

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 3

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": "1481068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1154865335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER STREET",
            "address_2": "2ND FLOOR CRED DEPT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410004",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 MARCUS AVE, 2ND FLOOR",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110422057",
            "telephone_number": "516-354-1600",
            "fax_number": "516-941-4677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 Bay Pkwy",
            "address_2": "Suite 901",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112046079",
            "country_code": "US",
            "telephone_number": "718-238-2100",
            "fax_number": "718-748-0863",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "96-10 Metropolitan Ave",
            "address_purpose": "LOCATION",
            "city": "Forest Hills",
            "state": "NY",
            "postal_code": "113756625",
            "country_code": "US",
            "telephone_number": "718-459-0400",
            "fax_number": "718-670-6479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLITO",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-07",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "308016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

Verify at the official NPI Registry.