Individual provider Active NPI

Jillian D'Amico

  • Surgical Physician Assistant
  • Staten Island, NY
National Provider Identifier
1477974384
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
017455 Issued in NY
Practice address
3333 Hylan Blvd
Staten Island, NY 10306-3608
Phone
(718) 448-3210
NPI assigned
Dec 18, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 25MP00318500 NJ
Surgical Physician Assistant 363AS0400X 017455 NY Primary

Addresses

Primary practice location

3333 Hylan Blvd
Staten Island, NY 10306-3608

Mailing address

111 Galway PL
Teaneck, NJ 07666-3640
Phone (201) 833-9500

Other names 1

  • Jillian Sarnelli Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140328000648 NJ Practitioner - Physician Assistant 1052542461 Reassigns benefits to 1 organization
I20160224000912 NY Practitioner - Physician Assistant 1052542461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

3333 Hylan Blvd
Staten Island, NY 10306-3608
Phone (516) 302-8180

36 Lincoln Ave
Rockville Centre, NY 11570-5768
Phone (516) 536-2800

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017455NYMDProfessional Counselor
25MP00318500NJMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC CurrentSince Sep 3, 2021 Accepting new patients
True North Medical Group PC CurrentSince Sep 3, 2021 Accepting new patients
True North Medical Group PC Past Accepting new patients

Locations

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

3333 Hylan Blvd
Staten Island, NY 10306
Phone (718) 667-3333

88 Old Town Rd
Staten Island, NY 10304
Phone (718) 979-4508

1099 Targee St
Staten Island, NY 10304

Networks

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

Interoperability endpoints

  • Direct secure messaging: jdamico70002@northwell.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1477974384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GALWAY PL",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663640",
            "telephone_number": "201-833-9500",
            "fax_number": "201-862-0095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063608",
            "telephone_number": "718-448-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AMICO",
        "first_name": "JILLIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-18",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00318500",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "017455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "SARNELLI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.