Active NPI
Mary Nickerson, PA
- Physician Assistant
- Carmel, NY
National Provider Identifier
1346316478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006250
- Practice address
- 75 Seminary Hill Rd
Carmel, NY 10512-1921 - Phone
- (518) 952-8142
- NPI assigned
- Nov 28, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006250 | NY | Primary |
Addresses
Primary practice location
75 Seminary Hill Rd
Carmel, NY 10512-1921
Mailing address
PO Box 31094
Hartford, CT 06150-1094
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
- Physician Assistant
- Education
- State University of New York at Stony Brook, School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
63 -36
Rego Park, NY 11374-1979
6336 99TH St
Rego Park, NY 11374-1979
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rego Park Counseling LLC | Current | Accepting new patients | |
| Rego Park Counseling LLC | Current | Accepting new patients | |
| Arms Acres Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Rego Park, NY
- NPI 1235760927
-
- Clinical Medical Laboratory
- Rego Park, NY
- NPI 1528759073
-
- Multi-Specialty Clinic/Center
- Fresh Meadows, NY
- NPI 1932061611
-
- Substance Abuse Rehabilitation Facility
- Carmel, NY
- NPI 1447271267
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1346316478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31094",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061501094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 SEMINARY HILL RD",
"city": "CARMEL",
"state": "NY",
"postal_code": "105121921",
"telephone_number": "518-952-8142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "MARY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "006250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmel, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.