NPIMap

Individual provider Active NPI

Cecilia Vanisky, N.P.

  • Obstetrics & Gynecology Nurse Practitioner
  • Port Jefferson Station, NY
National Provider Identifier
1225253222
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
360059 Issued in NY
Practice address
4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone
(631) 331-0500
Fax
(631) 331-1644
NPI assigned
Apr 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 360059 NY
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 360059 NY Primary

Addresses

Primary practice location

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363

Mailing address

900 Merchants Concourse Ste 216
Westbury, NY 11590-5114
Phone (516) 226-8373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160405002492 NY Practitioner - Nurse Practitioner 7719201300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Square Care Medical Group LLPGroup PAC ID 7012938434, 70 clinicians

Practice addresses (Care Compare)

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone (631) 331-0500

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Merit-based Incentive Payment System (MIPS)

Final score
87.62 of 100Reported as group
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

LicenseStateTypeSpecialty
360059NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Square Care Medical Group, LLP CurrentSince Mar 15, 2016 Accepting new patients
Dr. Jerry Ninia OB-GYN PLLC Past Accepting new patients
Jerry G Ninia MDPC Past Accepting new patients

Locations

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

4 Roosevelt Ave
Port Jefferson Station, NY 11776
Phone (631) 331-0500

900 Merchants Concourse
Ste 216
Westbury, NY 11590
Phone (516) 565-6322

Interoperability endpoints

  • Direct secure messaging: cecilia.vanisky.1@15987.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15987/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 7

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": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1225253222",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763363",
            "telephone_number": "631-331-0500",
            "fax_number": "631-331-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANISKY",
        "first_name": "CECILIA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "360059",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "360059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.