Individual provider Active NPI

Nina Smith, FNP-C

  • Family Nurse Practitioner
  • Syosset, NY
National Provider Identifier
1174174494
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F344765-01 Issued in NY
Practice address
575 Underhill Blvd Ste 175
Syosset, NY 11791-3417
Phone
(516) 921-6780
NPI assigned
Sep 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 685734-1 NY
Family Nurse Practitioner 363LF0000X F344765-01 NY Primary

Addresses

Primary practice location

575 Underhill Blvd Ste 175
Syosset, NY 11791-3417

Mailing address

260 Lincoln Ave
Sayville, NY 11782-1441
Phone (516) 660-1381

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
I20210614001600 NY Practitioner - Nurse Practitioner 6901206929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York Allergy Asthma and Immunology PCGroup PAC ID 6507127750, 12 clinicians

Practice addresses (Care Compare)

120 N Country Rd
Suite 1
Port Jefferson, NY 11777-2604
Phone (631) 474-7461

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
685734-1NYMDRegistered Nurse
F344765-01NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, P.C Past Accepting new patients

Organizations & group practices 2

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": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1174174494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 LINCOLN AVE",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117821441",
            "telephone_number": "516-660-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 UNDERHILL BLVD STE 175",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913417",
            "telephone_number": "516-921-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NINA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "685734-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F344765-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

Verify at the official NPI Registry.