Individual provider Active NPI

Beena Jacob

  • Adult Health Nurse Practitioner
  • Mineola, NY
National Provider Identifier
1699201970
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F307794-1 Issued in NY
Practice address
101 Mineola Blvd FL 2
Mineola, NY 11501-4089
Phone
(516) 663-3511
NPI assigned
May 5, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F307794-1 NY Primary

Addresses

Primary practice location

101 Mineola Blvd FL 2
Mineola, NY 11501-4089

Mailing address

285 E Main St Ste 105
Smithtown, NY 11787-2912

Other practice location 1

285 Middle Country Rd
Smithtown, NY 11787-2978
Phone (631) 509-0390

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bjacob265420@nyumc.direct-ci.com

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
I20170824002167 NY Practitioner - Nurse Practitioner 9234401340 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F307794-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Middle Country Endocrinology, PC CurrentSince Jul 9, 2017 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 CurrentSince Nov 24, 2018 Accepting new patients

Locations

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

300 Community Dr
Fl 1
Manhasset, NY 11030
Phone (516) 562-2252

101 Mineola Blvd
Fl 2
Mineola, NY 11501
Phone (516) 633-3511

300 Community Dr
Plandome, NY 11030

285 E Middle Country Rd
Ste 105
Smithtown, NY 11787
Phone (631) 509-0390

972 Brush Hollow Rd
Westbury, NY 11590

43 Crossways Park Dr W
Woodbury, NY 11797
Phone (516) 938-3000

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJCEAD

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1493942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1699201970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 E MAIN ST STE 105",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MINEOLA BLVD FL 2",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014089",
            "telephone_number": "516-663-3511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "285 Middle Country Rd",
            "address_purpose": "LOCATION",
            "city": "Smithtown",
            "state": "NY",
            "postal_code": "117872978",
            "country_code": "US",
            "telephone_number": "631-509-0390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "BEENA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-05",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307794-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bjacob265420@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "101 Mineola Blvd Fl 2",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115014089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.