Individual provider Active NPI

Anne-Marie Wise

  • Women's Health Nurse Practitioner
  • Mineola, NY
National Provider Identifier
1639555428
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
421221 Issued in NY
Practice address
120 Mineola Blvd
Suite 100
Mineola, NY 11501-4064
Phone
(516) 663-6925
Fax
(516) 663-4821
NPI assigned
Aug 4, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 421221 NY Primary

Addresses

Primary practice location

120 Mineola Blvd
Suite 100
Mineola, NY 11501-4064

Mailing address

120 Mineola Blvd
Suite 100
Mineola, NY 11501-4064
Phone (516) 663-6925

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awise222078@nyumc.direct-ci.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
I20151215001238 NY Practitioner - Nurse Practitioner 2860793973 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians
Square Care Medical Group LLPGroup PAC ID 7012938434, 70 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

191 Herricks Rd
Garden City Park, NY 11040-5236
Phone (516) 742-2224

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

Merit-based Incentive Payment System (MIPS)

Final score
87.62 of 100Reported as group
Quality
88.76
Promoting interoperability
100
Improvement activities
40
Cost
69.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Square Care Medical Group, LLP CurrentSince Jun 1, 2021 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
North Shore-Lij Medical PC Past Accepting new patients

Locations

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

1615 Northern Blvd
Ste 102
Manhasset, NY 11030
Phone (516) 487-2745

120 Mineola Blvd
Ste 100
Mineola, NY 11501
Phone (516) 663-2010

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

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

900 Merchants Concourse
Ste 216
Westbury, NY 11590
Phone (516) 565-6322

Networks

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

Interoperability endpoints

  • Direct secure messaging: awise222078@nyumc.direct-ci.com
  • Direct secure messaging: anne-marie.wise.1@15987.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15987/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1639555428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MINEOLA BLVD",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014064",
            "telephone_number": "516-663-6925",
            "fax_number": "516-663-4821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MINEOLA BLVD",
            "address_2": "SUITE 100",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014064",
            "telephone_number": "516-663-6925",
            "fax_number": "516-663-4821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "ANNE-MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-04",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "421221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awise222078@nyumc.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 Mineola Blvd",
            "address_2": "Suite 100",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115014064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.