Alicia Tamara Portuondo-Smith, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402195-1 Issued in NY

Practice address

189 Wheatley Rd
Glen Head, NY 11545-2641

Phone

(516) 686-4400

NPI assigned

Jun 17, 2010

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

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

Medicare enrollment (NPD)

Enrolled

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.

• Advantage Care Diagnostic and Treatment Center ,Inc

  • Federally Qualified Health Center (FQHC)
  • Brookville, NY
  • NPI 1073689600
  Medicare reassignment NPD

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1730400482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 WHEATLEY RD",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452641",
            "telephone_number": "516-686-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 WHEATLEY RD",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452641",
            "telephone_number": "516-686-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTUONDO-SMITH",
        "first_name": "ALICIA",
        "middle_name": "TAMARA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "590004",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402195-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leland W Petersen, CP
• Joyita Pinto, MS OTRL
• Alexandria Pironi
• Marisa Valarie Pollock, MA., CCC-SLP, TSSLD
• Sandra Portela
• Purple Table S.L.P., PLLC
• Pamela N Rademacher, LCSW
• Chithkala Ravishankar, MS RD CDE
• Shreyas T Ravishankar, MD
• Tharakaram Ravishankar, MD FACE

• Psychiatric/Mental Health Nurse Practitioner in Glen Head, NY
• Providers in Glen Head, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.