Marissa Lyann Carmine, PA -C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

023906 Issued in NY

Practice address

24 Old Fire House Rd
Wallkill, NY 12589-4600

Phone

(845) 393-6015

Fax

(845) 393-6016

NPI assigned

Jul 1, 2019

Last updated

Aug 6, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Marissa L Jimenez Former name

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cornerstone Family HealthcareGroup PAC ID 4880610393, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DGCECD
• Direct secure messaging: marissa.jimenez@csfh.eclinicaldirectplus.com

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.

• Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
  • NPI 1689669079
  Medicare reassignment Care Compare group NPD
• Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
  • NPI 1114757515
  NPD

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1467014472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 OLD FIRE HOUSE RD",
            "city": "WALLKILL",
            "state": "NY",
            "postal_code": "125894600",
            "telephone_number": "845-393-6015",
            "fax_number": "845-393-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMINE",
        "first_name": "MARISSA",
        "middle_name": "LYANN",
        "name_prefix": "Ms.",
        "credential": "PA -C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-01",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104428864-0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05823914",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "JIMENEZ",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gloria Breau, LPN
• Nicole June Brissette, DPT
• Hailee Brown
• Morgan B Bush
• Erica Campo
• Ivette Mari Carrion-Dimarco, MSED CCC-SLP
• Kara Renee Carrion, MSED
• Brenda F Cemelli, LMHC, LPC, CASAC,
• Trinity Marie Chapman-Clark, LPN
• Berline Charles Duc, FNP

• Physician Assistant in Wallkill, NY
• Providers in Wallkill, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.