Active NPI
Scott Joseph Bertolino
- Physician Assistant
- Lindenhurst, NY
National Provider Identifier
1477019495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 023827-01
- Practice address
- 556 Pecan St
Lindenhurst, NY 11757-4712 - Phone
- (516) 313-3606
- NPI assigned
- Feb 14, 2019
- Sex
- Male
- 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 | 023827-01 | NY | Primary |
Addresses
Primary practice location
556 Pecan St
Lindenhurst, NY 11757-4712
Mailing address
556 Pecan St
Lindenhurst, NY 11757-4712
Phone (516) 313-3606
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200309001754 | NY | Practitioner - Physician Assistant | 4082042866 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023827 | NY | MD | Clinical Child & Adolescent Psychologist |
| 023827-01 | NY | MD | Physician Assistant |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1477019495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 PECAN ST",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "117574712",
"telephone_number": "516-313-3606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "556 PECAN ST",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "117574712",
"telephone_number": "516-313-3606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTOLINO",
"first_name": "SCOTT",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-14",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "023827-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lindenhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.