Individual provider Active NPI

Phyllis Marie Garcia, PA-C

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1376869990
Registry record updated Aug 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
012096 Issued in NY
Practice address
4802 10TH Ave
Brooklyn, NY 11219-2916
Phone
(718) 283-6000
NPI assigned
Apr 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 012096 NY Primary

Addresses

Primary practice location

4802 10TH Ave
Brooklyn, NY 11219-2916

Mailing address

2545 W 17TH St
Brooklyn, NY 11214-6907
Phone (347) 538-3413

Other identifiers 1

IdentifierTypeStateIssuer
03766525MedicaidNY

Other names 1

  • Phyllis Marie Vitale Former name

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
I20210826002876 NY Practitioner - Physician Assistant 4880909837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercy College, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

103 Jackson Ave
B
Syosset, NY 11791-3624
Phone (516) 537-9062

2640 Merrick Rd
Bellmore, NY 11710-5715
Phone (516) 537-9064

3631 Hempstead Tpke
63A
Levittown, NY 11756-1315
Phone (516) 537-9063

377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061

5165 Merrick Rd
Massapequa Park, NY 11762-3728
Phone (516) 858-3724

683 Sunrise Hwy
Lynbrook, NY 11563-3246
Phone (516) 441-2155

71 Forest Ave
Glen Cove, NY 11542-2112
Phone (347) 493-2941

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012096NYMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: phyllis.garcia@ghuc.eclinicaldirectplus.com
  • Direct secure messaging: phyllisvitale@nslijmedgr.allscriptsdirect.net

Organizations & group practices 1

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": "1270684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629504000000",
    "number": "1376869990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 W 17TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112146907",
            "telephone_number": "347-538-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "PHYLLIS",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-08",
        "last_updated": "2021-08-21",
        "certification_date": "2021-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03766525",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "VITALE",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.