Individual provider Active NPI

Sabri Sellaouti, AGNP-C

  • Nurse Practitioner
  • Binghamton, NY
National Provider Identifier
1528642634
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
310398 Issued in NY
Practice address
169 Riverside Dr
Binghamton, NY 13905-4198
Phone
(607) 352-3550
NPI assigned
May 6, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 722513 NY
Nurse Practitioner 363L00000X 310398 NY Primary

Addresses

Primary practice location

169 Riverside Dr
Binghamton, NY 13905-4198

Mailing address

169 Riverside Dr
Binghamton, NY 13905-4246
Phone (607) 352-3550

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sabri.sellaouti@direct.lourdes.com Direct

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
I20210929001379 NY Practitioner - Nurse Practitioner 1557768819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

169 Riveride Dr
Binghamton, NY 13905-4246
Phone (607) 352-3550

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
722513NYMDCritical Care Medicine Registered Nurse
310398NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. Nurse Practitioner CurrentSince Oct 20, 2021 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Oct 20, 2021 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. Current Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

Interoperability endpoints

  • Direct secure messaging: ssellaouti196738@direct-guthrie.org

Organizations & group practices 4

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 1

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": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1528642634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 RIVERSIDE DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054246",
            "telephone_number": "607-352-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 RIVERSIDE DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054198",
            "telephone_number": "607-352-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELLAOUTI",
        "first_name": "SABRI",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-06",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NY",
            "license": "722513",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "310398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sabri.sellaouti@direct.lourdes.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "169 Riverside Dr",
            "city": "Binghamton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "139054246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.