NPIMap

Individual provider Active NPI

Bobbi Alfred Pellegrino, PA-C

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1750512018
Registry record updated Jul 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013458 Issued in NY
Practice address
1099 Targee Street
Staten Island, NY 10304-4310
Phone
(718) 448-3210
Fax
(718) 815-3379
NPI assigned
Aug 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 013458 NY
Physician Assistant 363A00000X 013458 NY Primary

Addresses

Primary practice location

1099 Targee Street
Staten Island, NY 10304-4310

Mailing address

1099 Targee Street
Administration
Staten Island, NY 10304-4310
Phone (718) 448-3210

Other identifiers 1

IdentifierTypeStateIssuer
03226386MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131212000245 NJ Practitioner - Physician Assistant 0345364220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Costa Orthopedics LLCGroup PAC ID 7315474947, 3 clinicians

Practice addresses (Care Compare)

135 RT
35 Suite 7
Eatontown, NJ 07724
Phone (732) 440-7322

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.28 of 100Reported as group
Quality
43.41
Promoting interoperability
87
Improvement activities
40
Cost
65.01

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013458NYMDMedical Physician Assistant

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFGGDD/Endpoint/HFGGDD

Organizations & group practices 1

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.

Hospital & facility affiliations 7

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": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278460800000",
    "number": "1750512018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 TARGEE STREET",
            "address_2": "ADMINISTRATION",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044310",
            "telephone_number": "718-448-3210",
            "fax_number": "718-720-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 TARGEE STREET",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044310",
            "telephone_number": "718-448-3210",
            "fax_number": "718-815-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLEGRINO",
        "first_name": "BOBBI",
        "middle_name": "ALFRED",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-05",
        "last_updated": "2010-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013458",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03226386",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.