NPIMap

Individual provider Active NPI

Rachel Guketlov, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1518477306
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00456200 Issued in NJ
Practice address
1275 York Ave
New York, NY 10065-6007
Phone
(212) 639-2000
NPI assigned
Oct 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 25MP00456200 NJ Primary

Addresses

Primary practice location

1275 York Ave
New York, NY 10065-6007

Mailing address

97 Gaskin Ave
Spotswood, NJ 08884-1183
Phone (732) 501-2876

Other practice location 1

1 Riverview Plz
Red Bank, NJ 07701-1864
Phone (732) 741-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180208001320 NJ Practitioner - Physician Assistant 7416217617 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MSK MonmouthGroup PAC ID 1153619291, 300 clinicians

Practice addresses (Care Compare)

136 Mountain View Blvd
Basking Ridge, NJ 07920-3444

136 Mountainview Blvd
Basking Ridge, NJ 07920-3444
Phone (908) 542-3000

480 Red Hill Rd
Middletown, NJ 07748-3052
Phone (908) 542-3007

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.57 of 100Reported as group
Quality
72.31
Improvement activities
40
Cost
76.55

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
80.94
Improvement activities
40
Cost
65.19

Merit-based Incentive Payment System (MIPS)

Final score
80.37 of 100Reported as group
Quality
71.5
Improvement activities
40
Cost
70.5

National Provider Directory

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

Networks

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

Interoperability endpoints

  • Direct secure messaging: rguketlov29669@mskcc.direct-ci.com

Organizations & group practices 6

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 5

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": "1507161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1518477306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 GASKIN AVE",
            "city": "SPOTSWOOD",
            "state": "NJ",
            "postal_code": "088841183",
            "telephone_number": "732-501-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656007",
            "telephone_number": "212-639-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Riverview Plz",
            "address_purpose": "LOCATION",
            "city": "Red Bank",
            "state": "NJ",
            "postal_code": "077011864",
            "country_code": "US",
            "telephone_number": "732-741-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUKETLOV",
        "first_name": "RACHEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-05",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00456200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.