Jessica Petchonka, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

018131 Issued in NY

Practice address

496 County Road 111
Building B
Manorville, NY 11949-3383

Phone

(631) 405-3200

Fax

(631) 395-6010

NPI assigned

Oct 4, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jessica.petchonka@ghuc.eclinicaldirectplus.com
• Direct secure messaging: jpetchonka699916@nyumc.direct-ci.com

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.

• North Shore Lij, Urgent Care, P.C.

  • Urgent Care Clinic/Center
  • Rockville Centre, NY
  • NPI 1679970891
  Medicare reassignment Care Compare group
• New York University

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  NY

  Medicare reassignment NPD
• Peconic Bay Primary Medical Care

  • Internal Medicine Physician
  • Mattituck, NY
  • NPI 1487620613
  Medicare reassignment
• New York University

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD
• House Medical PLLC

  • Internal Medicine Physician
  • Ronkonkoma, NY
  • NPI 1134768591
  NPD (past)

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

{
    "created_epoch": "1412380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1518360536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 OLD COUNTRY RD",
            "address_2": "SUITE 2",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012121",
            "telephone_number": "631-645-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 COUNTY ROAD 111",
            "address_2": "BUILDING B",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119493383",
            "telephone_number": "631-405-3200",
            "fax_number": "631-395-6010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "148 Natures Ln",
            "address_purpose": "LOCATION",
            "city": "Miller Place",
            "state": "NY",
            "postal_code": "117643137",
            "country_code": "US",
            "telephone_number": "631-636-6888",
            "fax_number": "631-209-5129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETCHONKA",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-04",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peconic Bay Medical Center
• Peconic Bay Medical Services, P.C.
• Toni J Peeling, R.N.
• Colleen Marie Pennica
• Lisa Marie Perrino, R.N.
• Debra Peters, CASAC-T, CARC
• Kerri Ann Petitpain
• Karen Diers Piddoubny, LBA
• PLC Optical Corp
• Krystal A Porfidia

• Physician Assistant in Manorville, NY
• Providers in Manorville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.