Individual provider Active NPI

Kelly Vanessa Amaya

  • Family Nurse Practitioner
  • Islandia, NY
National Provider Identifier
1548801020
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
344697 Issued in NY
Practice address
3001 Expressway Dr N
Islandia, NY 11749-5301
Phone
(631) 292-6747
NPI assigned
Oct 4, 2019
Last updated
Oct 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 344697 NY Primary

Addresses

Primary practice location

3001 Expressway Dr N
Islandia, NY 11749-5301

Mailing address

815 Commack Rd
Brentwood, NY 11717-7409

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
I20200212001327 NY Practitioner - Nurse Practitioner 9830525765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 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)

376 E Main St
Bay Shore, NY 11706-8405
Phone (631) 539-5400

Hospital & facility affiliations

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Lij OB GYN PC CurrentSince Jan 6, 2020 Accepting new patients
North Shore-Lij Medical PC CurrentSince Mar 15, 2022 Accepting new patients
North Shore - Lij Medical PC CurrentSince Mar 15, 2022 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Past Accepting new patients

Locations

376 E Main St
Bay Shore, NY 11706
Phone (631) 273-3080

376 E Main St
Ste 201
Bay Shore, NY 11706
Phone (631) 273-3080

270 Park Ave
Huntington, NY 11743
Phone (631) 351-2308

3001 Express Dr N
Islandia, NY 11749
Phone (631) 292-6747

300 Community Dr
Manhasset, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: kamaya61238@northwell.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1548801020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 COMMACK RD",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117177409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 EXPRESSWAY DR N",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495301",
            "telephone_number": "631-292-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMAYA",
        "first_name": "KELLY",
        "middle_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-04",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "344697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islandia, NY

Sources for this page

Verify at the official NPI Registry.