NPIMap

Individual provider Active NPI

Nicole Marie McDermott, PA-C

  • Medical Physician Assistant
  • Bethpage, NY
National Provider Identifier
1811918345
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
008886-1 Issued in NY
Practice address
4045 Hempstead Tpke FL 3
Bethpage, NY 11714-5611
Phone
(516) 731-7770
Fax
(516) 541-1721
NPI assigned
Jul 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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 0010-00180 NC
Medical Physician Assistant 363AM0700X 008886-1 NY Primary

Addresses

Primary practice location

4045 Hempstead Tpke FL 3
Bethpage, NY 11714-5611

Mailing address

4045 Hempstead Tpke FL 3
Bethpage, NY 11714-5611
Phone (516) 731-7770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120502000259 NY Practitioner - Physician Assistant 2365448453 Reassigns benefits to 2 organizations
I20200723001828 SC Practitioner - Physician Assistant 2365448453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-0580

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5220

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

PO Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
008886-1NYMDPsychologist
0010-00180NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Oct 23, 2023 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Oct 23, 2023 Accepting new patients
Carolina Endocrine, P.a. Past Accepting new patients
Optum Urgent Care, PLLC Past Accepting new patients
Rheumatology Associates of L.I., LLP Past Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients
Rheumatology Associates of L.I., LLP Past Accepting new patients

Locations

500 Commack Rd
Ste 103
Commack, NY 11725
Phone (631) 638-0160

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

4 Smith Haven Mall
Ste 203
Lake Grove, NY 11755
Phone (631) 444-0561

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 10

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 6

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1811918345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 HEMPSTEAD TPKE FL 3",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145611",
            "telephone_number": "516-731-7770",
            "fax_number": "516-541-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 HEMPSTEAD TPKE FL 3",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145611",
            "telephone_number": "516-731-7770",
            "fax_number": "516-541-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-00180",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "008886-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

Verify at the official NPI Registry.