Individual provider Active NPI

Diane A Collins, FNP-C

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1205422649
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
353246 Issued in NY
Practice address
622 W 168TH St PH 5-505
New York, NY 10032-3720
Phone
(212) 305-6494
NPI assigned
Dec 20, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11009758 FL
Family Nurse Practitioner 363LF0000X 353246 NY Primary

Addresses

Primary practice location

622 W 168TH St PH 5-505
New York, NY 10032-3720

Mailing address

2424 Huron Cir
Kissimmee, FL 34746-3437
Phone (754) 207-6565

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
I20241205002072 NY Practitioner - Nurse Practitioner 6002342771 Reassigns benefits to 3 organizations

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
Kings Medical Family Practice, P.C.Group PAC ID 4082989645, 18 clinicians

Practice addresses (Care Compare)

1295 Broadway
Brooklyn, NY 11221-2973
Phone (718) 682-3903

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11009758FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Nov 4, 2024 Accepting new patients
Kings Medical Family Practice PC CurrentSince Sep 1, 2025 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Ag Urgent Care, P.C. CurrentSince Sep 1, 2025 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Nov 4, 2024 Accepting new patients

Locations

4809 Avenue N
Brooklyn, NY 11234
Phone (718) 252-4120

9525 Church Ave
Brooklyn, NY 11212
Phone (718) 513-6178

9525 Church Ave
#Y
Brooklyn, NY 11212

1771 Utica Ave
Brooklyn, NY 11234
Phone (718) 209-0888

1295 Broadway
Brooklyn, NY 11221
Phone (718) 682-3903

16814 Jamaica Ave
Jamaica, NY 11432
Phone (718) 650-5553

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
Ph 5505
New York, NY 10032
Phone (212) 305-6494

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

NPI Registry JSON

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

{
    "created_epoch": "1608422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1205422649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 HURON CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347463437",
            "telephone_number": "754-207-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST PH 5-505",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-6494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "DIANE",
        "middle_name": "A",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-20",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11009758",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "353246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.