Individual provider Active NPI

Andrea Joy Moullin-Heddle, LCSW

  • Clinical Social Worker
  • East Northport, NY
National Provider Identifier
1184818460
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
079364 Issued in NY
Practice address
5 Purdy Ave
East Northport, NY 11731-4501
Phone
(917) 751-7425
NPI assigned
Aug 30, 2007
Last updated
Aug 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 068239 NY
Clinical Social Worker 1041C0700X 079364 NY Primary

Addresses

Primary practice location

5 Purdy Ave
East Northport, NY 11731-4501

Mailing address

5 Purdy Ave
East Northport, NY 11731-4501
Phone (917) 751-7425

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140805001956 NY Practitioner - Clinical Social Worker 7911124524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

1554 Northern Boulevard
1St Floor
Manhasset, NY 11030-3006
Phone (516) 734-8500

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

State licenses

LicenseStateTypeSpecialty
079364NYMDClinical Social Worker
068239NYMDMedical license number

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Mar 27, 2022 Accepting new patients

Locations

1554 Northern Blvd
Fl 1
Manhasset, NY 11030
Phone (516) 472-5860

300 Community Dr
Manhasset, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Organizations & group practices 1

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": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1184818460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PURDY AVE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117314501",
            "telephone_number": "917-751-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PURDY AVE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117314501",
            "telephone_number": "917-751-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULLIN-HEDDLE",
        "first_name": "ANDREA",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "068239",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Northport, NY

Sources for this page

Verify at the official NPI Registry.