Magdalena Tibett

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

017830 Issued in NY

Practice address

1111 Montauk Hwy
Suite 3-1
West Islip, NY 11795-4910

Phone

(631) 669-1171

NPI assigned

Aug 5, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Island Gastroenterology Consultants PC

  • Specialist
  • West Islip, NY
  • NPI 1174556963
  Medicare reassignment

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419897600000",
    "number": "1619386570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MONTAUK HIGHWAY",
            "address_2": "SUITE 3-1",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954910",
            "telephone_number": "631-669-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MONTAUK HWY",
            "address_2": "SUITE 3-1",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954910",
            "telephone_number": "631-669-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBETT",
        "first_name": "MAGDALENA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Viola Thalhamer III, M.S.ED., B.,C.S.E
• Jacqueline Rose Thaw
• The Stop & Shop Supermarket Company LLC
• Renee Meyatta Thomas, MD
• Janet Thompson, R.N.
• Howard M Tichler, DDS
• Timothy George M.D., P.C.
• Emily Tirado
• Danielle Tisser, DO
• Thomas Joseph Tomaselli, MD

• Physician Assistant in West Islip, NY
• Providers in West Islip, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.