Idalissie Altagracia Peguero, APN, PMHNPBC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ00838200 Issued in NJ

Practice address

550 Broad St Ste 606
Newark, NJ 07102-4537

Phone

(201) 822-1161

Fax

(877) 485-8918

NPI assigned

Aug 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

JLS Medical PCGroup PAC ID 7719342005, 53 clinicians

Care Plus NJ IncGroup PAC ID 9436160553, 52 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Care Plus NJ, Inc.

  • Community/Behavioral Health Agency
  • Paramus, NJ
  • NPI 1356394555
  Medicare reassignment Care Compare group NPD
• JLS Medical PC

  • Psychiatry Physician
  • Newark, NJ
  • NPI 1164007043

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• G&S Medical Associates LLC

  • Internal Medicine Physician
  • Paterson, NJ
  • NPI 1982982336
  Medicare reassignment NPD
• Grow Healthcare Group of New Jersey PC

  • Mental Health Counselor
  • Hoboken, NJ
  • NPI 1841949328
  Medicare reassignment
• Care Plus New Jersey, Inc.

  • Community/Behavioral Health Agency
  • Paramus, NJ
  • NPI 1629307863
  NPD
• Care Plus NJ, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Morris Plains, NJ
  • NPI 1902655970
  NPD
• Bancroft, a New Jersey Nonprofit Corporation

  • Rehabilitation Clinic/Center
  • Cherry Hill, NJ
  • NPI 1720121106
  NPD (past)

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1689154437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 BROADWAY",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141916",
            "telephone_number": "973-523-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 BROAD ST STE 606",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071024537",
            "telephone_number": "201-822-1161",
            "fax_number": "877-485-8918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 Broadway",
            "address_purpose": "LOCATION",
            "city": "Paterson",
            "state": "NJ",
            "postal_code": "075141916",
            "country_code": "US",
            "telephone_number": "973-523-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEGUERO",
        "first_name": "IDALISSIE",
        "middle_name": "ALTAGRACIA",
        "name_prefix": "Ms.",
        "credential": "APN, PMHNPBC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00838200",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00838200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655881",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sudeep Peddireddy, MD
• Pediaric Center 2000 Inc
• Pediatric Hospital Associates, P.a.
• Helio F Pedro, M.D.
• Peers Understanding Strategies for Healing & Help
• Stephanie Peguero, RN
• Mingzhuo Pei
• Daniel Peikes, DMD
• Pemberton M.D P.C
• Clyde A. Pemberton, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Newark, NJ
• Providers in Newark, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.