NPIMap

Individual provider Active NPI

Melissa Pei-Lih Jaccom, PA-C

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Uniondale, NY
National Provider Identifier
1467965095
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
021449 Issued in NY
Practice address
333 Earle Ovington Blvd
Uniondale, NY 11553-3610
Phone
(516) 222-8881
NPI assigned
Nov 6, 2017
Last updated
Apr 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 021449 NY Primary

Addresses

Primary practice location

333 Earle Ovington Blvd
Uniondale, NY 11553-3610

Mailing address

10106 67TH Dr Apt 6B
Forest Hills, NY 11375-2774
Phone (973) 580-3877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180522000329 NY Practitioner - Physician Assistant 6002171071 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

535 E 70TH St
New York, NY 10021-4823
Phone (212) 774-7598

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York Society for Releif of the Ruptured and Crippled Maintaining CurrentSince Jan 3, 2022 Accepting new patients
New York Society for the Relief of Ruptured & Crippled Maintaining Past Accepting new patients

Locations

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1467965095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10106 67TH DR APT 6B",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752774",
            "telephone_number": "973-580-3877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 EARLE OVINGTON BLVD",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115533610",
            "telephone_number": "516-222-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACCOM",
        "first_name": "MELISSA",
        "middle_name": "PEI-LIH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-06",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NY",
            "license": "021449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Uniondale, NY

Sources for this page

Verify at the official NPI Registry.