Ivy Medical Group PLLC
Organization Active NPI Emergency Medicine Physician · New York, NY
NPI 1700558798 · NPPES record last updated Apr 23, 2026
Key facts
- NPI
- 1700558798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- IVY MEDICAL GROUP PLLC
- Practice address
- 885 3Rd Ave FL 28
New York, NY 10022-4834 - Phone
- (929) 650-3990
- Fax
- (929) 996-6230
- NPI assigned
- Sep 29, 2021
- Organization subpart
- No
Authorized official
- Name
- Faige Miller
- Title
- Authorized Official
- Phone
- (718) 534-0689
Practitioners 188
-
Louise Aka Ezoua, CRNP
-
Jennifer H Cavage, GNP
-
Kellie Boeggeman Dearden, ARNP
-
Diana Luciano, CRNP
-
Stacy Ann Macfarlane, APRN
-
Dair Melendez-Drier, LMHC
-
Susan Samuels, FNP
-
Rahaf Balani, ARNP
-
Andrietta Wright Barnett, DNP FNP-C PMHNP-BC
-
Nakia E Bartlett, APRN
-
Wendy Nicole Bell, NURSE PRACTITIONER
-
Marianne M Blair, FNP-C, AGACNP-BC
-
Erica Brown, FNP
-
Kristina Jean Brown, FNP-BC
-
Tasha Bryant, FNP-BC
-
Krystal Coutcher, PA-C
-
Brittany L Demelio, AGACNP
-
Christopher Diethert, FNP-C
-
Joseph D Fagbohun, DNP,APRN,FNP-BC,NP-C
-
Elsa Ashley Frederic, APRN
-
Juliana Hagan, CRNP
-
Jennifer J Hale, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (29 enrollments) in WV, NY, FL, PA, MD, NH, DE, ME, VT, CT, OH, RI, MO, AL, TN, VA, NC, DC, IL, KY, MS, WA, TX, LA, NM, SD, AR, MA, CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220131000462 | WV | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 49 practitioners Practice locations: Hurricane, WV |
| O20230109000901 | NY | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 80 practitioners Practice locations: Albany, NY; New York, NY |
| O20230313000522 | FL | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 82 practitioners Practice locations: Miami, FL; Sarasota, FL |
| O20241227001555 | PA | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 86 practitioners Practice locations: Lancaster, PA |
| O20250103000441 | MD | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 42 practitioners Practice locations: Baltimore, MD |
| O20250103002026 | NH | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 54 practitioners Practice locations: Concord, NH |
| O20250106000092 | DE | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 36 practitioners Practice locations: Seaford, DE |
| O20250106000437 | ME | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 49 practitioners Practice locations: Westbrook, ME |
| O20250107000751 | VT | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 37 practitioners Practice locations: Saint Albans, VT |
| O20250107001834 | CT | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 36 practitioners Practice locations: Stamford, CT |
| O20250110002632 | OH | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 55 practitioners Practice locations: Cleveland, OH; Kettering, OH |
| O20250115000879 | RI | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 34 practitioners Practice locations: Cumberland, RI |
| O20250128003863 | MO | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 24 practitioners Practice locations: Jefferson City, MO |
| O20250129000195 | AL | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 31 practitioners Practice locations: Tuscumbia, AL |
| O20250130003214 | TN | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 37 practitioners Practice locations: La Follette, TN |
| O20250205003048 | VA | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 52 practitioners Practice locations: Fredericksburg, VA |
| O20250217002168 | NC | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 39 practitioners Practice locations: Mount Olive, NC |
| O20250312000177 | DC | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 24 practitioners Practice locations: Lanham, MD |
| O20250325003950 | IL | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 35 practitioners Practice locations: Schaumburg, IL |
| O20250708004487 | KY | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 22 practitioners Practice locations: Winchester, KY |
| O20260225002601 | MS | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 12 practitioners Practice locations: Meridian, MS |
| O20260427001847 | WA | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 28 practitioners Practice locations: Moses Lake, WA |
| O20260522000016 | TX | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 18 practitioners Practice locations: Stephenville, TX |
| O20260526003658 | LA | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 19 practitioners Practice locations: Alexandria, LA |
| O20260527003117 | NM | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 24 practitioners Practice locations: Albuquerque, NM |
| O20260528000996 | SD | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 3 practitioners Practice locations: Mitchell, SD |
| O20260528004537 | AR | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 6 practitioners Practice locations: Mountain Home, AR |
| O20260601001158 | MA | Part B Supplier - Clinic/Group Practice | 4981097797 |
Receives reassigned benefits from 7 practitioners Practice locations: Framingham, MA |
| O20260602003902 | CA | Part B Supplier - Clinic/Group Practice | 4981097797 | Practice locations: Daly City, CA |
National Provider Directory
Locations
1551 Sawgrass Corporate Pkwy
Ste 410
Sunrise, FL 33323
418 Broadway
Ste N
Albany, NY 12207
Phone (201) 278-8966
885 3rd Ave
New York, NY 10022
Phone (212) 906-1200
596 Sheldon Rd
Saint Albans, VT 05478
Phone (802) 524-6534
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
885 3Rd Ave FL 28
New York, NY 10022-4834
Mailing address
885 3Rd Ave FL 28
New York, NY 10022-4834
Phone (929) 650-3990
Other practice location 1
100 Chambers St
Cumberland, RI 02864-7724
Phone (929) 650-3990
Other practice location 2
1150 W Dorothy LN
Kettering, OH 45409-1305
Phone (929) 650-3990
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.