Individual provider Active NPI

Basilia Ricciardo, RPA-C

  • Medical Physician Assistant
  • Carle Place, NY
National Provider Identifier
1457651200
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
002955 Issued in NY
Practice address
536 Mineola Ave
Carle Place, NY 11514-1716
Phone
(516) 671-9800
NPI assigned
Oct 27, 2010
Last updated
Apr 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 002955 NY Primary

Addresses

Primary practice location

536 Mineola Ave
Carle Place, NY 11514-1716

Mailing address

536 Mineola Ave
Carle Place, NY 11514-1716

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
I20110715000108 NY Practitioner - Physician Assistant 7517135601 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002955NYMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Winthrop Community Medical Affiliates, P.C. CurrentSince Jul 1, 2018 Accepting new patients
Senior Healthcare Associates, LLC Past Accepting new patients

Locations

700 Hicksville Rd
Ste 204
Bethpage, NY 11714
Phone (516) 576-5812

536 Mineola Ave
Carle Place, NY 11514
Phone (516) 333-5054

1 School St
Ste 203
Glen Cove, NY 11542
Phone (516) 671-9800

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242

300 Community Dr
Manhasset, NY 11030

Organizations & group practices 5

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": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1457651200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 MINEOLA AVE",
            "city": "CARLE PLACE",
            "state": "NY",
            "postal_code": "115141716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 MINEOLA AVE",
            "city": "CARLE PLACE",
            "state": "NY",
            "postal_code": "115141716",
            "telephone_number": "516-671-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICCIARDO",
        "first_name": "BASILIA",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-27",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "002955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carle Place, NY

Sources for this page

Verify at the official NPI Registry.