Active NPI
Jacqueline Pandolfi, N.P.
- Women's Health Nurse Practitioner
- Port Jefferson Station, NY
National Provider Identifier
1225197866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 388956-1
- Practice address
- 12 Medical Dr
Port Jefferson Station, NY 11776-1588 - Phone
- (631) 331-4400
- Fax
- (631) 331-3190
- NPI assigned
- Dec 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 388956-1 | NY | Primary |
Addresses
Primary practice location
12 Medical Dr
Port Jefferson Station, NY 11776-1588
Mailing address
900 Merchants Concourse Ste 216
Westbury, NY 11590-5114
Phone (516) 226-8373
Other practice location 1
807 S Oyster Bay Rd
Bethpage, NY 11714-1030
Phone (516) 822-0028 ext. 264
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 388956 | Medicaid | NY |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
12 Medical Dr
Suite a
Port Jefferson Station, NY 11776-1588
Phone (631) 331-4400
Hospital & facility affiliations
- John T Mather Memorial Hospital of Port Jefferson
- Suny/Stony Brook University Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.62 of 100
- Quality
- 88.76
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 69.99
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 388956-1 | NY | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skills Unlimited, Inc. | 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.
-
- Obstetrics & Gynecology Physician
- Woodbury, NY
- NPI 1457392763
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Oakdale, NY
- NPI 1487789392
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Port Jefferson, NY
- NPI 1093718728
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1225197866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 MERCHANTS CONCOURSE STE 216",
"city": "WESTBURY",
"state": "NY",
"postal_code": "115905114",
"telephone_number": "516-226-8373",
"fax_number": "844-632-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 MEDICAL DR",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117761588",
"telephone_number": "631-331-4400",
"fax_number": "631-331-3190"
}
],
"practiceLocations": [
{
"address_1": "807 S Oyster Bay Rd",
"address_purpose": "LOCATION",
"city": "Bethpage",
"state": "NY",
"postal_code": "117141030",
"country_code": "US",
"telephone_number": "516-822-0028 x264",
"fax_number": "516-342-2480",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PANDOLFI",
"first_name": "JACQUELINE",
"name_prefix": "Ms.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-08",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "NY",
"license": "388956-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "388956",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.