Individual provider Active NPI

Jeanne Louise Ceballos, NP

  • Family Nurse Practitioner
  • Albany, NY
National Provider Identifier
1639168107
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
331484 Issued in NY
Practice address
47 New Scotland Ave
Albany, NY 12208-3412
Phone
(518) 262-5226
Fax
(518) 262-6261
NPI assigned
Oct 18, 2005
Last updated
May 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 331484 NY Primary

Addresses

Primary practice location

47 New Scotland Ave
Albany, NY 12208-3412

Mailing address

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5226

Other practice location 1

63 Shaker Rd Ste G01
Albany, NY 12204-1030
Phone (518) 213-1443

Other identifiers 1

IdentifierTypeStateIssuer
02001669MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

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
I20040615001815 NY Practitioner - Nurse Practitioner 1456335678 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince Sep 3, 2002 Accepting new patients
Albany Medical College CurrentSince Sep 3, 2002 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. CurrentSince Sep 25, 2017 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
St. Peter's Health Partners Medical Associates, P.C. CurrentSince Sep 25, 2017 Accepting new patients

Locations

16 New Scotland Ave
Albany, NY 12208
Phone (518) 262-4942

43 New Scotland Ave
Albany, NY 12208
Phone (518) 262-5149

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

47 New Scotland Ave
#139
Albany, NY 12208
Phone (518) 262-3773

47 New Scotland Ave
#52
Albany, NY 12208
Phone (518) 262-8936

47 New Scotland Ave
#61
Albany, NY 12208
Phone (518) 262-5791

63 Shaker Rd
Ste G01
Albany, NY 12204
Phone (518) 213-1443

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

Interoperability endpoints

  • Direct secure messaging: jceballos834493@direct.trinity-health.org

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1639168107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 NEW SCOTLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083412",
            "telephone_number": "518-262-5226",
            "fax_number": "518-262-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 NEW SCOTLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083412",
            "telephone_number": "518-262-5226",
            "fax_number": "518-262-6261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "63 Shaker Rd Ste G01",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122041030",
            "country_code": "US",
            "telephone_number": "518-213-1443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEBALLOS",
        "first_name": "JEANNE",
        "middle_name": "LOUISE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-18",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "331484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02001669",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP- Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "63 Shaker Rd Ste G01",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122041030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.