Individual provider Active NPI

Rachael Willard, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockville Centre, NY
National Provider Identifier
1770313744
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F406262-01 Issued in NY
Practice address
100 N Village Ave Ste 27
Rockville Centre, NY 11570-3712
Phone
(516) 900-7646
NPI assigned
Aug 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 237006 LA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F406262-01 NY Primary

Addresses

Primary practice location

100 N Village Ave Ste 27
Rockville Centre, NY 11570-3712

Mailing address

835 Teddy Ave
Slidell, LA 70458-3337
Phone (719) 320-6686

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
I20241113003270 NY Practitioner - Nurse Practitioner 9638603624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Empire NP Psychiatry PCGroup PAC ID 2668884321, 10 clinicians

Practice addresses (Care Compare)

100 N Village Ave
Suite 27
Rockville Centre, NY 11570-3712
Phone (516) 900-7646

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
237006LAMDPsychiatric/Mental Health Nurse Practitioner
F406262-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Empire NP Psychiatry PC Psychiatric/Mental Health CurrentSince Sep 1, 2024 Accepting new patients

Locations

100 N Village Ave
Ste 27
Rockville Ctr, NY 11570
Phone (516) 277-6121

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.

NPI Registry JSON

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1770313744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 TEDDY AVE",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583337",
            "telephone_number": "719-320-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N VILLAGE AVE STE 27",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703712",
            "telephone_number": "516-900-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "RACHAEL",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "237006",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F406262-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.