Jennis H Pae, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

60249651 Issued in NY

Practice address

1305 York Ave
11TH FL
New York, NY 10021-5663

Phone

(646) 962-2020

NPI assigned

Jul 23, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Ophthalmology

Education

Rutgers School of Dental Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Ophthalmology

  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Redwood City, CA
  • NPI 1639252604

  Ophthalmology

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1376708966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 E 70TH ST APT 23E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 YORK AVE",
            "address_2": "11TH FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215663",
            "telephone_number": "646-962-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAE",
        "first_name": "JENNIS",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "60249651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "901 Nevin Ave",
            "city": "Richmond",
            "state": "CA",
            "country_code": "US",
            "postal_code": "948013143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Theresa Cannizzaro Padula, SLP
• Anna Padva German, DDS
• Sylvie Pady, LPN
• Anna Pae
• Calvin Pae, DMD
• Robert Pae, M.D.
• Aija Paegle, P.T.
• Chul Paek
• Sydney Eden Paek
• Taylor Paek, DMD

• Ophthalmology Physician in New York, NY
• Providers in New York, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.