Active NPI
Nicole Elizabeth Jarck, PA-C, MSPAS
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1457130726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PENDING
- Practice address
- 2525 Kings Hwy
Brooklyn, NY 11229-1705 - Phone
- (718) 692-5300
- NPI assigned
- Sep 26, 2023
- Last updated
- Sep 26, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PENDING | NY | Primary |
Addresses
Primary practice location
2525 Kings Hwy
Brooklyn, NY 11229-1705
Mailing address
43 Waterman Ave
Rumson, NJ 07760-2038
Phone (732) 759-5008
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031023 | NY | MD | Occupational Therapist |
| PENDING | NY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MMC Pediatrics Faculty Practice | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- nicole.jarck.1@30057.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Brooklyn, NY
- NPI 1982708202
-
- Pediatrics Physician
- Brooklyn, NY
- NPI 1285648154
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1457130726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 WATERMAN AVE",
"city": "RUMSON",
"state": "NJ",
"postal_code": "077602038",
"telephone_number": "732-759-5008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 KINGS HWY",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112291705",
"telephone_number": "718-692-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARCK",
"first_name": "NICOLE",
"middle_name": "ELIZABETH",
"credential": "PA-C, MSPAS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-26",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "PENDING",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.