Individual provider Active NPI

Lauren A Lopera, PA

  • Medical Physician Assistant
  • Ronkonkoma, NY
National Provider Identifier
1184874687
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
010551-1 Issued in NY
Practice address
122 Portion Rd
Ronkonkoma, NY 11779-4174
Phone
(631) 588-6665
Fax
(631) 580-5543
NPI assigned
Sep 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 010551-1 NY Primary

Addresses

Primary practice location

122 Portion Rd
Ronkonkoma, NY 11779-4174

Mailing address

122 Portion Rd
Ronkonkoma, NY 11779-4174
Phone (631) 588-6665

Other identifiers 1

IdentifierTypeStateIssuer
010551-01OtherNYNYS REGISTRATION CERTIFICATE

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
I20230127000977 NY Practitioner - Physician Assistant 9931570090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ismail Ozcan MD PCGroup PAC ID 1456456458, 3 clinicians

Practice addresses (Care Compare)

122 Portion Rd
Lake Ronkonkoma, NY 11779-4174
Phone (631) 588-6665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
010551-1NYMDMedical Physician Assistant

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1184874687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 PORTION RD",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117794174",
            "telephone_number": "631-588-6665",
            "fax_number": "631-580-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 PORTION RD",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117794174",
            "telephone_number": "631-588-6665",
            "fax_number": "631-580-5543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPERA",
        "first_name": "LAUREN",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-22",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "010551-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS REGISTRATION CERTIFICATE",
            "identifier": "010551-01",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

Verify at the official NPI Registry.