Jeff Richard Pavell, DO
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Bardonia, NY
NPI 1790769487 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1790769487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- MB69881 (NJ)
- Practice address
- 365 Route 304
Ste 102
Bardonia, NY 10954-1601 - Phone
- (845) 624-2182
- Fax
- (845) 624-2188
- NPI assigned
- Dec 6, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Physical Medicine and Rehabilitation Center PA
Practice addresses (Care Compare)
365 Route 304
Suite 102
Bardonia, NY 10954-1601
Phone (845) 624-2182
500 Grand Ave
Englewood, NJ 07631-4968
Phone (201) 567-2277
Hospital & facility affiliations
- Englewood Hospital and Medical Center
- Holy Name Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100208000006 | NJ | Practitioner - Physical Medicine and Rehabilitation | 2769574953 | Reassigns benefits to 1 organization |
| I20101217000850 | NY | Practitioner - Physical Medicine and Rehabilitation | 2769574953 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MB69881 | NJ | MD | Physical Medicine & Rehabilitation Physician |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Interoperability endpoints
- jpavell@rehabmed.ssdirect.aprima.com
- jpavell190105@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 202584 | NY | |
| Physical Medicine & Rehabilitation Physician | 208100000X | MB69881 | NJ | Yes |
Addresses
Primary practice location
365 Route 304
Ste 102
Bardonia, NY 10954-1601
Mailing address
500 Grand Ave
Englewood, NJ 07631-4967
Phone (201) 567-2277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804550 | Medicaid | NJ | |
| DO7698000 | Other | NJ | CDS |
Other providers in Bardonia, NY
- Julie Needelman
- New Hope Behavioral Health, NP in Psychiatry PLLC
- Nisha Lakhani MD PC
- Jennifer Olarsch
- Sandra Ortiz
- Anthony J Pecoraro
- Stephanie M Peralta
- Anthony Ray Perkins
- Angella Maria Baldevia Pielago
- Rizza Mae Baldevia Pielago
All providers in Bardonia, NY · Physical Medicine & Rehabilitation Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.