Individual provider Active NPI

Anne Katherine Molloy, APRN

  • Adult Health Nurse Practitioner
  • Stony Brook, NY
National Provider Identifier
1205145299
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209014981 Issued in IL
Practice address
101 Nicolls Rd # Hsct10
Stony Brook, NY 11794-0001
Phone
(631) 632-9510
NPI assigned
Sep 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 404564 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209014981 IL
Adult Health Nurse Practitioner 363LA2200X 209014981 IL Primary

Addresses

Primary practice location

101 Nicolls Rd # Hsct10
Stony Brook, NY 11794-0001

Mailing address

101 Nicolls Rd # Hsct10
Stony Brook, NY 11794-0001
Phone (631) 632-9510

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address anne.molloy@stonybrookmedicine.edu

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
I20221114002655 NY Practitioner - Nurse Practitioner 8628358132 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

169 Putnam Hall
South Campus
Stony Brook, NY 11794-8790
Phone (631) 632-8850

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209014981ILMDPsychiatric/Mental Health Nurse Practitioner
404564NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Psychiatric Associates, University Faculty Practice Corpor CurrentSince Nov 28, 2022 Accepting new patients
University Hospital at Stony Brook PastSince Dec 13, 2022 Accepting new patients

Locations

169 Putnam Hall
Stony Brook, NY 11794
Phone (631) 632-8850

Networks

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

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.

Hospital & facility affiliations 6

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": "1285372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1205145299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD # HSCT10",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-632-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD # HSCT10",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-632-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLOY",
        "first_name": "ANNE",
        "middle_name": "KATHERINE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-25",
        "last_updated": "2022-12-05",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404564",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209014981",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209014981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "anne.molloy@stonybrookmedicine.edu",
            "affiliation": "N",
            "address_1": "101 Nicolls Rd # Hsct10",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117940001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.