Nicole Rose Marino, PA-C
Individual provider Active NPI Physician Assistant · Hollis Hills, NY
NPI 1467904508 · NPPES record last updated Oct 25, 2016
Key facts
- NPI
- 1467904508
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 20058 (NY)
- Practice address
- 7943 211TH St
Hollis Hills, NY 11364-3225 - Phone
- (646) 530-1480
- NPI assigned
- Oct 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Shore-Lij Medical PC
Practice addresses (Care Compare)
300 Community Dr
Manhasset, NY 11030-3816
300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229
330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550
350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845
900 Franklin Ave
Valley Stream, NY 11580-2145
Phone (516) 719-5024
Hospital & facility affiliations
- Long Island Jewish Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 79.77
- Promoting interoperability
- 88.77
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170505000409 | NY | Practitioner - Physician Assistant | 6002193752 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020058 | NY | MD | Massage Therapist |
| 20058 | NY | MD | Medical Physician Assistant |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 20058 | NY | Yes |
| Medical Physician Assistant | 363AM0700X | 20058 | NY | |
| Surgical Physician Assistant | 363AS0400X | 20058 | NY |
Addresses
Primary practice location
7943 211TH St
Hollis Hills, NY 11364-3225
Mailing address
7943 211TH St
Hollis Hills, NY 11364-3225
Phone (646) 530-1480
Other providers in Hollis Hills, NY
- Malka Belgrod
- Excellent DME, Inc.
- Giggles Early Intervention Occupational Therapy, Speech Language Patho
- Heffron Chiropractic Office
- Virginia Macpherson
- Deepika Modi
- Lawrence M Wells
All providers in Hollis Hills, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.