Individual provider Active NPI

Bettina Manduca

  • Internal Medicine Physician
  • Jackson Heights, NY
National Provider Identifier
1538573779
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
285737 Issued in NY
Practice address
3722 82ND St
2ND Floor
Jackson Heights, NY 11372-7032
Phone
(347) 756-0997
NPI assigned
Jun 16, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 285737 NY Primary

Addresses

Primary practice location

3722 82ND St
2ND Floor
Jackson Heights, NY 11372-7032

Mailing address

3722 82ND St
2ND Floor
Jackson Heights, NY 11372-7032
Phone (347) 756-0997

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161230000274 NY Practitioner - Internal Medicine 7113208398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3722 82ND St
Jackson Heights, NY 11372-7040
Phone (718) 879-1600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
285737NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Medical Group of the Mount Sinai School of Medicine Internal Medicine CurrentSince Feb 1, 2020 Accepting new patients
North Shore Medical Group of the Mount Sinai School of Medicine Internal Medicine CurrentSince Feb 1, 2020 Accepting new patients

Locations

3712 82nd St
Jackson Hts, NY 11372
Phone (718) 879-1600

3722 82nd St
Jackson Hts, NY 11372
Phone (718) 779-1600

9901 Queens Blvd
Rego Park, NY 11374
Phone (718) 268-4500

Networks

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

Organizations & group practices 2

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 7

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": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1538573779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3722 82ND ST",
            "address_2": "2ND FLOOR",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727032",
            "telephone_number": "347-756-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3722 82ND ST",
            "address_2": "2ND FLOOR",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727032",
            "telephone_number": "347-756-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDUCA",
        "first_name": "BETTINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-16",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "285737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.