Individual provider Active NPI

Jimyeong Son

  • Adult Health Nurse Practitioner
  • Manhasset, NY
National Provider Identifier
1548915622
Registry record updated Jul 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
1557056 Issued in NY
Practice address
400 Community Dr
Manhasset, NY 11030-3815
Phone
(833) 454-8377
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 1557056 NY Primary

Addresses

Primary practice location

400 Community Dr
Manhasset, NY 11030-3815

Mailing address

400 Community Dr
Manhasset, NY 11030-3815
Phone (516) 472-5800

Other practice location 1

261 E 78th St
New York, NY 10075-1216
Phone (833) 454-8377

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
I20230628002695 NY Practitioner - Nurse Practitioner 1850750548 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
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

13617 39TH Ave
Suite Cfe
Flushing, NY 11354-5504
Phone (718) 562-2229

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

State licenses

LicenseStateTypeSpecialty
1557056NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince May 17, 2023 Accepting new patients
North Shore-Lij Medical PC CurrentSince May 17, 2023 Accepting new patients

Locations

3765 Riverdale Ave
Ste 3
Bronx, NY 10463
Phone (212) 988-1071

480 Bedford Rd
Ste 1
Chappaqua, NY 10514

13617 39th Ave
Ste Cfe
Flushing, NY 11354
Phone (718) 559-3600

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

261 E 78th St
New York, NY 10075
Phone (212) 249-4501

300 Community Dr
Plandome, NY 11030

Networks

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

Interoperability endpoints

  • Direct secure messaging: json60851@northwell.direct-ci.com

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 3

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": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657929600000",
    "number": "1548915622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303815",
            "telephone_number": "516-472-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303815",
            "telephone_number": "833-454-8377"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "261 E 78th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100751216",
            "country_code": "US",
            "telephone_number": "833-454-8377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SON",
        "first_name": "JIMYEONG",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-07-16",
        "certification_date": "2022-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "1557056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.