Jacqueline Woodburn, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

033652 Issued in NY

Practice address

129 Sunrise Hwy W
East Patchogue, NY 11772-1846

Phone

(631) 230-5774

NPI assigned

Mar 31, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

City Medical of Upper East Side PLLCGroup PAC ID 0648465039, 658 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.woodburn.1@2983.direct.athenahealth.com

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.

• City Medical of Upper East Side, PLLC

  dba CityMD Urgent Care

  • Urgent Care Clinic/Center
  • New York, NY
  • NPI 1801277629
  Medicare reassignment Care Compare group
• City Medical of Upper East Side, PLLC

  • Urgent Care Clinic/Center
  • New York, NY
  • NPI 1740913763
  NPD
• City Medical of Upper East Side, PLLC

  dba CityMD Urgent Care

  • Urgent Care Clinic/Center
  • Riverhead, NY
  • NPI 1811485188
  NPD

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

{
    "created_epoch": "1743379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1710780028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 THUNDER RD",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414426",
            "telephone_number": "631-972-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 SUNRISE HWY W",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117721846",
            "telephone_number": "631-230-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODBURN",
        "first_name": "JACQUELINE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-31",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "033652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wexler & Lengyel-Kremenic MD PC (Diabetes and Endocrinology Center of Suffolk)
• Laura D. Wilk, PA-C
• William James Friedel DDS P.C. (William Friedel DDS P.C.)
• Winthrop Community Medical Affiliates PC (Long Island Cardiology Associates)
• Keith Magnus Witt, D.O.
• Daniela Yepez Romero, MD
• Dina Yusupova, MD
• Juan C. Zapata, M.D.
• John Phillip Zauner, RPH
• Joseph Michael Zehentner, DPM

• Physician Assistant in East Patchogue, NY
• Providers in East Patchogue, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.