Jiyoung Back, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

338354 Issued in NJ

Practice address

26 Greenville Ave
Jersey City, NJ 07305

Phone

(201) 333-8222

Fax

(201) 333-9500

NPI assigned

Jun 27, 2014

Last updated

Mar 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jiyoung.back@direct.hobokenumc.md

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.

• Matrix Medical of New York PC

  • Nurse Practitioner
  • New York, NY
  • NPI 1639433063
  Medicare reassignment NPD
• Humc Opco LLC

  dba Hoboken University Hospital

  • General Acute Care Hospital
  • Hoboken, NJ
  • NPI 1043475668
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1598170656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 GREENVILLE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073052608",
            "telephone_number": "201-333-8222",
            "fax_number": "201-333-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 GREENVILLE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07305",
            "telephone_number": "201-333-8222",
            "fax_number": "201-333-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 Kennedy Boulevard",
            "address_purpose": "LOCATION",
            "city": "Jersey City",
            "state": "NJ",
            "postal_code": "07305",
            "country_code": "US",
            "telephone_number": "201-333-8222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACK",
        "first_name": "JIYOUNG",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-27",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "338354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0595624",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jiyoung.back.2@14360.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "26 Greenville Ave",
            "city": "Jersey City",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "07305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• B&T Medical Transport LLC (B&T Medical Transort LLC)
• Aneeqa Babar, DO
• Farrukh Babar
• Jonathan Babia, RN
• Raenelle Bacchus, LCSW, LCADC
• Lauren Bacotti, BCBA
• Tanzeela Badar
• Amr Badawy, D.O.
• Badawy Mohamed Badawy, M.D.
• Mary Badawy, PHARM.D.

• Nurse Practitioner in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.