Individual provider Active NPI

Adam R Bruccoleri, P.A.

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1629381124
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014091 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(718) 226-9158
Fax
(718) 226-6964
NPI assigned
Jul 26, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014091 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-9158

Other identifiers 1

IdentifierTypeStateIssuer
03277983MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101115000012 NY Practitioner - Physician Assistant 7517152739 Reassigns benefits to 1 organization
I20210902000176 NJ Practitioner - Physician Assistant 7517152739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

3333 Hylan Blvd
Staten Island, NY 10306-3608
Phone (516) 302-8180

36 Lincoln Ave
Rockville Centre, NY 11570-5768
Phone (516) 536-2800

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-9292

Hospital & facility affiliations

  • Staten Island University Hospital Hospital, Staten Island, NY, CCN 330160

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014091NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC Physician Assistant CurrentSince May 28, 2021 Accepting new patients
True North Medical Group PC CurrentSince May 28, 2021 Accepting new patients
True North Medical Group PC Past Accepting new patients

Locations

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

3333 Hylan Blvd
Staten Island, NY 10306
Phone (718) 667-3333

3311 Hylan Blvd
Staten Island, NY 10306
Phone (718) 351-3111

375 Seguine Ave
Staten Island, NY 10309
Phone (718) 226-2000

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

25 Fanning St
Staten Island, NY 10314
Phone (347) 671-8399

1099 Targee St
Staten Island, NY 10304

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

Networks

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

Interoperability endpoints

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

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.

Hospital & facility affiliations 1

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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1629381124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9158",
            "fax_number": "718-226-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9158",
            "fax_number": "718-226-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCCOLERI",
        "first_name": "ADAM",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03277983",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.