Individual provider Active NPI

Marisa Rose Doll, PA-C

  • Physician Assistant
  • Yaphank, NY
National Provider Identifier
1831865534
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5585 Issued in SC
Practice address
527 Boulevard E
Yaphank, NY 11980-7512
Phone
(631) 504-0427
NPI assigned
Aug 22, 2021
Last updated
Feb 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 027122 NY
Physician Assistant 363A00000X 5585 SC Primary

Addresses

Primary practice location

527 Boulevard E
Yaphank, NY 11980-7512

Mailing address

101 Hospital Rd
Patchogue, NY 11772-4870
Phone (631) 745-2857

Other practice location 1

101 Hospital Rd
Patchogue, NY 11772-4870
Phone (631) 654-7100

Other practice location 2

905 Verdae Blvd Ste 101
Greenville, SC 29607-4098
Phone (864) 990-1910

Other names 1

  • Marisa Balbo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210928001199 NY Practitioner - Physician Assistant 7719384189 Reassigns benefits to 2 organizations
I20250310003645 SC Practitioner - Physician Assistant 7719384189 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Urgent Care of South Carolina PCGroup PAC ID 1254703788, 158 clinicians

Practice addresses (Care Compare)

1305 S Suber Rd
Greer, SC 29650-0944
Phone (864) 989-4609

3025 Wade Hampton Blvd
Taylors, SC 29687-2715
Phone (864) 643-2340

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
027122NYMDPhysician Assistant
5585SCMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: mdoll831857@direct.ghs.myhfn.org

Organizations & group practices 3

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": "1629590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1831865534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL RD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-745-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 BOULEVARD E",
            "city": "YAPHANK",
            "state": "NY",
            "postal_code": "119807512",
            "telephone_number": "631-504-0427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Patchogue",
            "state": "NY",
            "postal_code": "117724870",
            "country_code": "US",
            "telephone_number": "631-654-7100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "905 Verdae Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296074098",
            "country_code": "US",
            "telephone_number": "864-990-1910",
            "fax_number": "864-990-1911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLL",
        "first_name": "MARISA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-22",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027122",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "BALBO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Yaphank, NY

Sources for this page

Verify at the official NPI Registry.