Individual provider Active NPI

Jennifer Pantoliano

  • Adult Health Nurse Practitioner
  • Stony Brook, NY
National Provider Identifier
1295277572
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
308041 Issued in NY
Practice address
2500 Route 347 BLDG 14a
Stony Brook, NY 11790-2554
Phone
(631) 689-7800
NPI assigned
Nov 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 308041 NY Primary

Addresses

Primary practice location

2500 Route 347 BLDG 14a
Stony Brook, NY 11790-2554

Mailing address

2500 Route 347 BLDG 14a
Stony Brook, NY 11790-2554

Other identifiers 1

IdentifierTypeStateIssuer
308041OtherNYLICENSE

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
I20170303000309 NY Practitioner - Nurse Practitioner 3173807583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

2500 Nesconset Hwy
BLDG 14a
Stony Brook, NY 11790-2554
Phone (631) 751-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
308041NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Hematology Oncology Associates PC CurrentSince Aug 14, 2019 Accepting new patients
Samaritan Medical Services, P.C. CurrentSince Jul 1, 2020 Accepting new patients

Locations

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

5316 Nesconset Hwy
Ste 101
Port Jefferson Station, NY 11776

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

2500 Route 347
Bldg 14A
Stony Brook, NY 11790
Phone (631) 689-7000

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

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 1

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": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1295277572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ROUTE 347 BLDG 14A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 ROUTE 347 BLDG 14A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902554",
            "telephone_number": "631-689-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTOLIANO",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "308041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "308041",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.