Individual provider Active NPI

Jacqueline Medina

  • Mental Health Counselor
  • Yonkers, NY
National Provider Identifier
1295120954
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
73 Market St
Yonkers, NY 10710-7616
Phone
(914) 848-8030
Fax
(914) 848-8031
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

73 Market St
Yonkers, NY 10710-7616

Mailing address

800 Westchester Ave Ste N715
Rye Brook, NY 10573-1369
Phone (908) 588-3635

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240722000328 NY Practitioner - Mental Health Counselor 9234675778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Westchester Medical Group, P.CGroup PAC ID 6406752963, 410 clinicians

Practice addresses (Care Compare)

73 Market St
Yonkers, NY 10710-7602
Phone (914) 682-0700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009701NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Group, P.C. CurrentSince Jul 1, 2024 Accepting new patients
The Westchester Medical Group PC CurrentSince Jul 1, 2024 Accepting new patients

Locations

1345 Avenue of the Americas
Fl 8
New York, NY 10105
Phone (212) 913-0828

800 Westchester Ave
Ste N715
Rye Brook, NY 10573
Phone (914) 607-5730

210 Westchester Ave
White Plains, NY 10604
Phone (914) 681-3100

73 Market St
Yonkers, NY 10710
Phone (914) 848-8030

Networks

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1295120954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WESTCHESTER AVE STE N715",
            "city": "RYE BROOK",
            "state": "NY",
            "postal_code": "105731369",
            "telephone_number": "908-588-3635",
            "fax_number": "908-934-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 MARKET ST",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107107616",
            "telephone_number": "914-848-8030",
            "fax_number": "914-848-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

Verify at the official NPI Registry.