Individual provider Active NPI

Samantha Dai Pernick

  • Physical Therapist
  • Great Neck, NY
National Provider Identifier
1730735044
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
045785 Issued in NY
Practice address
475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone
(516) 829-0030
Fax
(516) 466-7723
NPI assigned
Aug 13, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 34854 FL
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 045785 NY Primary

Addresses

Primary practice location

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802

Mailing address

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone (516) 829-0030

Other practice location 1

309 Northwest Dr
Farmingdale, NY 11735-4935
Phone (516) 420-2900

Other practice location 2

11135 S Jog Rd Ste 1
Boynton Beach, FL 33437-1817
Phone (561) 752-3820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200721002680 NY Practitioner - Physical Therapist in Private Practice 0446682397 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9525 Queens Blvd
Suite 3D
Rego Park, NY 11374-4510
Phone (718) 925-6212

Merit-based Incentive Payment System (MIPS)

Final score
97.89 of 100Reported as individual
Quality
94.11
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34854FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Reddy Care Physical Therapy PC Single Specialty CurrentSince Jul 3, 2020 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic CurrentSince Oct 1, 2020 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Single Specialty CurrentSince Oct 1, 2020 Accepting new patients
Montefiore Medical Center Single Specialty CurrentSince Jul 1, 2021 Accepting new patients
Montefiore Medical Center CurrentSince Jul 1, 2021 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

309 Northwest Dr
Farmingdale, NY 11735
Phone (516) 420-2900

340 Dogwood Ave
Franklin Square, NY 11010
Phone (516) 437-5300

475 Northern Blvd
Ste 11
Great Neck, NY 11021
Phone (516) 344-0023

9525 Queens Blvd
Ste 3D
Rego Park, NY 11374
Phone (718) 925-6212

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1730735044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 11",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 11",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 Northwest Dr",
            "address_purpose": "LOCATION",
            "city": "Farmingdale",
            "state": "NY",
            "postal_code": "117354935",
            "country_code": "US",
            "telephone_number": "516-420-2900",
            "fax_number": "516-420-2908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11135 S Jog Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Boynton Beach",
            "state": "FL",
            "postal_code": "334371817",
            "country_code": "US",
            "telephone_number": "561-752-3820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERNICK",
        "first_name": "SAMANTHA",
        "middle_name": "DAI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-13",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "34854",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.