NPIMap

Individual provider Active NPI

Stacey Berroa, FNP-BC

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1841063104
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
352385 Issued in NY
Practice address
130 E 77TH St
New York, NY 10075-1851
Phone
(212) 434-3900
NPI assigned
Oct 30, 2023
Last updated
Oct 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 352385 NY Primary

Addresses

Primary practice location

130 E 77TH St
New York, NY 10075-1851

Mailing address

130 E 77TH St
New York, NY 10075-1851

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240313004063 NY Practitioner - Nurse Practitioner 2365888237 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Suffolk Primary Health LLCGroup PAC ID 9436420510, 46 clinicians

Practice addresses (Care Compare)

170 Old Country Rd
Riverhead, NY 11901-2198
Phone (631) 208-4460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Suffolk Primary Health, LLC CurrentSince Jan 1, 2026 Accepting new patients
Vantage Medical Associates PC CurrentSince Oct 1, 2025 Accepting new patients
Vantage Medical Associates NJ PC Current Accepting new patients

Locations

5308 13th Ave
Ste 334
Brooklyn, NY 11219

1612 Central Ave
Ste 201
Far Rockaway, NY 11691
Phone (516) 792-1600

170 Old Country Rd
Riverhead, NY 11901
Phone (631) 208-4460

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IFCJCD
  • Direct secure messaging: sberroa61068@northwell.direct-ci.com

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.

Hospital & facility affiliations 7

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": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1841063104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751851",
            "telephone_number": "212-434-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERROA",
        "first_name": "STACEY",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "352385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.