Individual provider Active NPI

Pollyanna Wilson, FNP

  • Family Nurse Practitioner
  • Far Rockaway, NY
National Provider Identifier
1487884276
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
335079 Issued in NY
Practice address
1048 Beach 20TH St
Far Rockaway, NY 11691-3900
Phone
(718) 765-6342
Fax
(929) 374-1132
NPI assigned
Jul 15, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 335079 NY Primary

Addresses

Primary practice location

1048 Beach 20TH St
Far Rockaway, NY 11691-3900

Mailing address

PO Box 746087
Atlanta, GA 30374-6087
Phone (312) 733-9730

Other practice location 1

11515 Sutphin Blvd
Jamaica, NY 11434-1020
Phone (718) 765-6009

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pwilson330901@nyumc.direct-ci.com NYU Langone Hospitals

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190924003316 NY Practitioner - Nurse Practitioner 8022232875 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Griffin Myers Medical PCGroup PAC ID 5294145017, 78 clinicians

Practice addresses (Care Compare)

1048 Beach 20TH St
Far Rockaway, NY 11691-3900
Phone (718) 765-6342

11515 Sutphin Blvd
Jamaica, NY 11434-1020
Phone (718) 765-6009

455 Sutter Ave
Brooklyn, NY 11212-8111
Phone (718) 765-6550

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Essen Medical Associates,PC CurrentSince Jul 1, 2020 Accepting new patients
Medical Director Services PC CurrentSince Oct 1, 2020 Accepting new patients
Essen Medical Urgicare, PLLC CurrentSince Jul 1, 2020 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
Griffin Myers Medical, P.C. Family CurrentSince Sep 10, 2022 Accepting new patients
Essen Medical Associates, PC CurrentSince Jul 1, 2020 Accepting new patients
NYU Langone Hospitals CurrentSince Oct 1, 2019 Accepting new patients
Essen Medical Associates, PC Current Accepting new patients
NYU Langone Hospitals CurrentSince Oct 1, 2019 Accepting new patients
House Call Medical Services of New York, PLLC CurrentSince Jul 1, 2020 Accepting new patients

Locations

1550 Dr Martin L King Jr Blvd
Bronx, NY 10452
Phone (347) 269-2366

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

1434 Williamsbridge Rd
Fl 2
Bronx, NY 10461
Phone (201) 641-2125

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

50 Sheffield Ave
Brooklyn, NY 11207
Phone (718) 250-8789

455 Sutter Ave
Brooklyn, NY 11212
Phone (718) 765-6550

1311 Virginia St
Far Rockaway, NY 11691
Phone (718) 327-2908

1048 Beach 20th St
Far Rockaway, NY 11691
Phone (718) 765-6342

8989 Union Tpke
Glendale, NY 11385
Phone (718) 480-6207

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

11515 Sutphin Blvd
Jamaica, NY 11434
Phone (718) 659-4000

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

Networks

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

Interoperability endpoints

  • Direct secure messaging: pollyanna.wilson@oakstreethealth.gwaydirect.com

Organizations & group practices 10

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": "1247616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1487884276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746087",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746087",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913900",
            "telephone_number": "718-765-6342",
            "fax_number": "929-374-1132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11515 Sutphin Blvd",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114341020",
            "country_code": "US",
            "telephone_number": "718-765-6009",
            "fax_number": "347-682-4302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "POLLYANNA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-15",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "335079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pwilson330901@nyumc.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "NYU Langone Hospitals",
            "address_1": "150 55th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112202559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Far Rockaway, NY

Sources for this page

Verify at the official NPI Registry.