Individual provider Active NPI

Priscilla Delello, PA

  • Physician Assistant
  • Brightwaters, NY
National Provider Identifier
1720014970
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008287 Issued in NY
Practice address
404 Potter Blvd
Brightwaters, NY 11718-1830
Phone
(631) 376-0055
Fax
(631) 376-0099
NPI assigned
Jun 22, 2006
Last updated
Sep 22, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18150 CA
Physician Assistant 363A00000X 008287 NY Primary

Addresses

Primary practice location

404 Potter Blvd
Brightwaters, NY 11718-1830

Mailing address

404 Potter Blvd
Brightwaters, NY 11718-1830
Phone (631) 376-0055

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
I20080328000169 NY Practitioner - Physician Assistant 4284643883 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

440 E Main St
Bay Shore, NY 11706-8501

450 Lakeville Rd
New Hyde Park, NY 11042-1118
Phone (516) 734-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Aug 6, 2018 Accepting new patients
North Shore Long Island Jewish Health Care Inc CurrentSince Mar 1, 2016 Accepting new patients

Locations

404 Potter Blvd
Brightwaters, NY 11718
Phone (631) 376-0055

300 Community Dr
Manhasset, NY 11030

450 Lakeville Rd
North New Hyde Park, NY 11042
Phone (516) 321-3000

118 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 376-0055

9525 Queens Blvd
Ste B
Rego Park, NY 11374
Phone (718) 925-6200

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: pdelello69643@northwell.direct-ci.com

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.

Hospital & facility affiliations 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1720014970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830",
            "telephone_number": "631-376-0055",
            "fax_number": "631-376-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830",
            "telephone_number": "631-376-0055",
            "fax_number": "631-376-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELELLO",
        "first_name": "PRISCILLA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18150",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brightwaters, NY

Sources for this page

Verify at the official NPI Registry.