Individual provider Active NPI

Gi Eun Cha, NP

  • Family Nurse Practitioner
  • Glenwood Landing, NY
National Provider Identifier
1396327417
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F347353-01 Issued in NY
Practice address
5 Betty LN
Glenwood Landing, NY 11547-3000
Phone
(646) 289-2202
NPI assigned
Apr 27, 2021
Last updated
Apr 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F347353-01 NY Primary

Addresses

Primary practice location

5 Betty LN
Glenwood Landing, NY 11547-3000

Mailing address

5 Betty LN
Glenwood Landing, NY 11547-3000
Phone (646) 289-2202

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
I20211013001368 NY Practitioner - Nurse Practitioner 6901204437 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Optum Urgent Care PLLCGroup PAC ID 8628299518, 68 clinicians

Practice addresses (Care Compare)

339 Main St
Huntington, NY 11743-6958
Phone (631) 470-9000

555 N Broadway
Jericho, NY 11753-2134
Phone (516) 597-5070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
347353NYMDLicensed Practical Nurse
F347353-01NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

Philadelphia, PA 19195

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1396327417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BETTY LN",
            "city": "GLENWOOD LANDING",
            "state": "NY",
            "postal_code": "115473000",
            "telephone_number": "646-289-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 BETTY LN",
            "city": "GLENWOOD LANDING",
            "state": "NY",
            "postal_code": "115473000",
            "telephone_number": "646-289-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHA",
        "first_name": "GI EUN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F347353-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood Landing, NY

Sources for this page

Verify at the official NPI Registry.