Individual provider Active NPI

Revalyn Thomas

  • Adult Health Nurse Practitioner
  • Forest Hills, NY
National Provider Identifier
1346848256
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
0236333 Issued in NY
Practice address
10814 72ND Ave
Forest Hills, NY 11375-7081
Phone
(718) 520-8480
NPI assigned
Oct 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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 0236333 NY Primary

Addresses

Primary practice location

10814 72ND Ave
Forest Hills, NY 11375-7081

Mailing address

10814 72ND Ave
Forest Hills, NY 11375-7081
Phone (718) 520-8480

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
I20231019002000 NY Practitioner - Nurse Practitioner 1759737273 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as apm
Quality
57.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0236333NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parker Jewish Institute for Health Care and Rehabilitation CurrentSince Aug 27, 2023 Accepting new patients
Care Connect Medical P.C. CurrentSince Mar 7, 2024 Accepting new patients
Parker Jewish Institute for Health Care and Rehabilitation CurrentSince Aug 27, 2023 Accepting new patients
Parker Jewish Institute for Health Care and Rehabilitation Past Accepting new patients
Robert Rothstein, MD PC PastSince Oct 19, 2020 Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

7 Skyline Dr
Ste 250
Hawthorne, NY 10532

27111 76th Ave
North New Hyde Pk, NY 11040
Phone (718) 289-2100

Organizations & group practices 5

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": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1346848256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10814 72ND AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757081",
            "telephone_number": "718-520-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10814 72ND AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757081",
            "telephone_number": "718-520-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "REVALYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "0236333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.