NPIMap

Individual provider Active NPI

Mia Kyong Ju Clar, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Great Neck, NY
National Provider Identifier
1609142793
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
278962 Issued in NY
Practice address
865 Northern Blvd
Suite 201
Great Neck, NY 11021-5335
Phone
(516) 708-2520
NPI assigned
Mar 22, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 278962 NY Primary

Addresses

Primary practice location

865 Northern Blvd
Suite 201
Great Neck, NY 11021-5335

Mailing address

18 Beatrice LN
Old Bethpage, NY 11804-1002
Phone (214) 315-7830

Other names 1

  • Mia Kyong Ju Barnett Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160729000376 NY Practitioner - Geriatric Medicine 1658664586 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
University of Texas Medical School at San Antonio, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

865 Northern Boulevard
Suite 201
Great Neck, NY 11021-5310
Phone (516) 708-2520

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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Jul 1, 2016 Accepting new patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2016 Accepting new patients

Locations

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

865 Northern Blvd
Ste 201
Great Neck, NY 11021
Phone (516) 622-5185

275 South St
Oyster Bay, NY 11771
Phone (516) 226-1383

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: miaclar@nslijmedgr.allscriptsdirect.net

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 8

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": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1609142793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 BEATRICE LN",
            "city": "OLD BETHPAGE",
            "state": "NY",
            "postal_code": "118041002",
            "telephone_number": "214-315-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 NORTHERN BLVD",
            "address_2": "SUITE 201",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215335",
            "telephone_number": "516-708-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAR",
        "first_name": "MIA",
        "middle_name": "KYONG JU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-22",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "278962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIA",
            "last_name": "BARNETT",
            "middle_name": "KYONG JU",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.