Jacqueline Forman

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

287977 Issued in NY

Practice address

222 Station PLZ N Ste 428
Mineola, NY 11501-3819

Phone

(516) 663-2066

NPI assigned

May 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Gastroenterology

Education

State University of New York Downstate Medical Center, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Digestive Healthcare Associates PCGroup PAC ID 4486546686, 16 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.8 of 100Reported as group

Quality

91.79

Promoting interoperability

100

Improvement activities

40

Cost

75.18

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Digestive Healthcare Associates, P.C.

  • Gastroenterology Physician
  • Great Neck, NY
  • NPI 1598952863
  Medicare reassignment Care Compare group NPD
• New York University

  dba NYU Faculty Group Practice

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  Gastroenterology, NY

  Medicare reassignment NPD
• Gastrointestinal Care of Long Island PLLC

  dba Allied Digestive Health Medical Group of New York

  • Gastroenterology Physician
  • Massapequa, NY
  • NPI 1265571863
  NPD
• New York University

  dba NYU Langone Ambulatory Care Chelsea

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1780020560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N STE 428",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013819",
            "telephone_number": "516-663-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N STE 428",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013819",
            "telephone_number": "516-663-2066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-20",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "287977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jforman230752@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "222 Station Plz N Ste 428",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115013819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Luz S Fonacier, M.D.
• Adrian Philip Fontanetta, MD
• Jeisson Ferney Fontecha Hernandez, M.D.
• Venercie Fontilus
• Jason Ford, MD
• Elizabeth Jane Foxen, M. D.
• Janice Marie Francischine-Syers, RN
• Frank a. Monteleone, M.D.,P.C.
• Jacklyn Frank, MD
• David Frankel, MD

• Gastroenterology Physician in Mineola, NY
• Providers in Mineola, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.
• 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.