Individual provider Active NPI

Jeanette Cholakis, NP

  • Nurse Practitioner
  • Bay Shore, NY
National Provider Identifier
1508510231
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F345500 Issued in NY
Practice address
39 Brentwood Rd Ste 201
Bay Shore, NY 11706-8031
Phone
(631) 968-8288
NPI assigned
Feb 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F345500 NY Primary

Addresses

Primary practice location

39 Brentwood Rd Ste 201
Bay Shore, NY 11706-8031

Mailing address

22 Wishbone LN
Wantagh, NY 11793-1236
Phone (917) 593-9671

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
I20220516000325 NY Practitioner - Nurse Practitioner 1254718141 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

301 E Main St
Bay Shore, NY 11706-8408
Phone (631) 968-3636

Hospital & facility affiliations

  • Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F345500NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Apr 12, 2022 Accepting new patients
North Shore-Lij Medical PC CurrentSince Apr 12, 2022 Accepting new patients
Peconic Bay Primary Medical Care PastSince Feb 13, 2022 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

39 Brentwood Rd
Ste 201
Bay Shore, NY 11706
Phone (631) 968-8288

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: jeanettecholakis@nslijmedgr.allscriptsdirect.net
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1644451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1508510231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WISHBONE LN",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931236",
            "telephone_number": "917-593-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 BRENTWOOD RD STE 201",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068031",
            "telephone_number": "631-968-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOLAKIS",
        "first_name": "JEANETTE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F345500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

Verify at the official NPI Registry.