Nicole Tetreault

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

284361 Issued in NY

Practice address

3757 Carman Rd Ste 100
Schenectady, NY 12303-5438

Phone

(518) 355-7063

Fax

(518) 357-0646

NPI assigned

Apr 15, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

Specialty

Family Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eddy Visiting Nurse & Rehab Association Home health agency, Troy, NY, CCN 337203
• Vna Home Health Home health agency, Albany, NY, CCN 337019
• Community Hospice, Inc, the Hospice, Albany, NY, CCN 331501
• St Peter'S Hospital Hospital, Albany, NY, CCN 330057
• Sunnyview Hospital and Rehabilitation Center Hospital, Schenectady, NY, CCN 330406
• Ellis Hospital Hospital, Schenectady, NY, CCN 330153

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicoletetreault@ccp.allscriptsdirect.net

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.

• Community Care Physicians, PLLC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1922048370

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Community Care Physicians, PC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1023380714
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993
  Care Compare affiliation
• Home Aide Service of Eastern New York, Inc.

  • Home Health Agency
  • Troy, NY
  • NPI 1114967924
  Care Compare affiliation
• St. Peter'S Hospital of the City of Albany

  • General Acute Care Hospital
  • Albany, NY
  • NPI 1497701106
  Care Compare affiliation
• Sunnyview Hospital and Rehabilitation Center

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1578664470
  Care Compare affiliation
• The Community Hospice Inc

  • Community Based Hospice Care Agency
  • Albany, NY
  • NPI 1588631733
  Care Compare affiliation
• Visiting Nurse Association of Albany, Inc.

  • Home Health Agency
  • Albany, NY
  • NPI 1295703551
  Care Compare affiliation
• Visiting Nurse Association of Albany, Inc.

  • Home Health Agency
  • Albany, NY
  • NPI 1992700165
  Care Compare affiliation

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

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1356784839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3757 CARMAN RD STE 100",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123035438",
            "telephone_number": "518-355-7063",
            "fax_number": "518-357-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETREAULT",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-15",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "284361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04849969",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5915911",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "J400411668",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUECROSS BLUESHIELD",
            "identifier": "8592D1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hadley Teitsworth
• Thomas Templeton
• Alexander B Tenenboym, M.D.
• Amanda Terry, RN
• Dawn Terry, PT
• William R Tetreault, M.D.
• Lisa Stacy Tharler, D.O.
• The Golub Corporation
• The Grab Bar Guy
• The Urban Counseling Experience LCSW PLLC

• Family Medicine Physician in Schenectady, NY
• Providers in Schenectady, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; 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.

Verify at the official NPI Registry.