Active NPI
Katrina Guglielmo, RPA-C
- Family Medicine Physician
- Saint James, NY
National Provider Identifier
1790909547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 005502
- Practice address
- 433 Lake Ave
Saint James, NY 11780-2207 - Phone
- (163) 158-4601
- NPI assigned
- Apr 12, 2007
- Last updated
- Oct 31, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 005502 | NY | Primary |
Addresses
Primary practice location
433 Lake Ave
Saint James, NY 11780-2207
Mailing address
200 Howells Rd
Bay Shore, NY 11706-5351
Phone (631) 666-1956
Other practice location 1
340 Howells Rd
Suite B
Bay Shore, NY 11706-5322
Phone (631) 666-1956
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005502 | Other | NY | NYS MEDICAL LICENSE NUMBE |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- katrinaguglielmo@dajrihcpc.allscriptsdirect.net
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698710400000",
"number": "1790909547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HOWELLS RD",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117065351",
"telephone_number": "631-666-1956",
"fax_number": "631-666-1957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "433 LAKE AVE",
"city": "SAINT JAMES",
"state": "NY",
"postal_code": "117802207",
"telephone_number": "163-158-4601"
}
],
"practiceLocations": [
{
"address_1": "340 Howells Rd",
"address_2": "Suite B",
"address_purpose": "LOCATION",
"city": "Bay Shore",
"state": "NY",
"postal_code": "117065322",
"country_code": "US",
"telephone_number": "631-666-1956",
"fax_number": "631-666-1957",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUGLIELMO",
"first_name": "KATRINA",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2023-10-31",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "005502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS MEDICAL LICENSE NUMBE",
"identifier": "005502",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint James, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.