Individual provider Active NPI

Jenna Ditommaso

  • Physician Assistant
  • Massapequa Park, NY
National Provider Identifier
1417595257
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4 Jones CT
Massapequa Park, NY 11762-3235
Phone
(516) 633-5393
NPI assigned
Dec 11, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

4 Jones CT
Massapequa Park, NY 11762-3235

Mailing address

4 Jones CT
Massapequa Park, NY 11762-3235
Phone (516) 633-5393

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
I20210601001790 NY Practitioner - Physician Assistant 0345649976 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Aug 23, 2023 Accepting new patients
New York University CurrentSince Aug 23, 2023 Accepting new patients

Locations

300 Community Dr
Plandome, NY 11030

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: jditommaso587657@nyumc.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1576022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1417595257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 JONES CT",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117623235",
            "telephone_number": "516-633-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 JONES CT",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117623235",
            "telephone_number": "516-633-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITOMMASO",
        "first_name": "JENNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-11",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa Park, NY

Sources for this page

Verify at the official NPI Registry.