Individual provider Active NPI

Susan Squillace, ANP-C

  • Adult Health Nurse Practitioner
  • Mineola, NY
National Provider Identifier
1598994881
Registry record updated Jul 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F3048861 Issued in NY
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 663-8312
NPI assigned
Jul 8, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2009

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 F3048861 NY Primary

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

700 Hicksville Rd
Suite 204
Bethpage, NY 11714-3471
Phone (516) 576-6106

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
I20110107000154 NY Practitioner - Nurse Practitioner 0042409922 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F3048861NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 1, 2021 Accepting new patients
New York University CurrentSince Oct 1, 2021 Accepting new patients
Samaritan Medical Services, P.C. CurrentSince Jun 20, 2017 Accepting new patients

Locations

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247011200000",
    "number": "1598994881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HICKSVILLE RD",
            "address_2": "SUITE 204",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143471",
            "telephone_number": "516-576-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-8312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUILLACE",
        "first_name": "SUSAN",
        "credential": "ANP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2009-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F3048861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.