Individual provider Active NPI

Anne Felicia Ambrose, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Lake Grove, NY
National Provider Identifier
1346218880
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
235243 Issued in NY
Practice address
Neurology Associates of Stony Brook
4 Smith Haven Mall Suite 105
Lake Grove, NY 11755-2412
Phone
(631) 444-2599
Fax
(631) 392-7213
NPI assigned
Mar 10, 2006
Last updated
Dec 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 235243 NY Primary
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician 2081P0301X 235243 NY

Addresses

Primary practice location

Neurology Associates of Stony Brook
4 Smith Haven Mall Suite 105
Lake Grove, NY 11755-2412

Mailing address

10 Bell Circle Road
Port Jefferson, NY 11777
Phone (631) 444-8118

Other practice location 1

5 E 98th St
Box 1240B
New York, NY 10029-6501
Phone (212) 241-9469

Other identifiers 1

IdentifierTypeStateIssuer
02588223MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040527001300 NY Practitioner - NeurologyPractitioner - Physical Medicine and Rehabilitation 5799766499 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Physical Medicine and Rehabilitation
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-2599

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (631) 638-1000

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai Diagnostic and Treatment Center CurrentSince Sep 1, 2004 Accepting new patients
Neurology Associates of Stony Brook, University Faculty Practice Corpo CurrentSince Nov 1, 2024 Accepting new patients
New York Spine & Brain Surgery, University Faculty Practice Corporatio PastSince Dec 22, 2024 Accepting new patients

Locations

4 Smith Haven Mall
Ste 105
Lake Grove, NY 11755

1470 Madison Ave
#1087
New York, NY 10029
Phone (212) 241-0349

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

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

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1346218880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 BELL CIRCLE ROAD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-444-8118",
            "fax_number": "631-392-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NEUROLOGY ASSOCIATES OF STONY BROOK",
            "address_2": "4 SMITH HAVEN MALL SUITE 105",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552412",
            "telephone_number": "631-444-2599",
            "fax_number": "631-392-7213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 E 98th St",
            "address_2": "Box 1240B",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296501",
            "country_code": "US",
            "telephone_number": "212-241-9469",
            "fax_number": "212-369-6389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMBROSE",
        "first_name": "ANNE",
        "middle_name": "FELICIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2024-12-18",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "235243",
            "primary": true
        },
        {
            "code": "2081P0301X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Brain Injury Medicine",
            "state": "NY",
            "license": "235243",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02588223",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Grove, NY

Sources for this page

Verify at the official NPI Registry.