Individual provider Active NPI

Jennifer M Mackoul, D.C.

  • Chiropractor
  • Staten Island, NY
National Provider Identifier
1851489900
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X011160-1 Issued in NY
Practice address
1235 Forest Hill Rd # C1
Staten Island, NY 10314-6314
Phone
(718) 987-2273
Fax
(718) 987-2277
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X011160-1 NY Primary

Addresses

Primary practice location

1235 Forest Hill Rd # C1
Staten Island, NY 10314-6314

Mailing address

1235 Forest Hill Rd Ste C1
Staten Island, NY 10314-6314
Phone (718) 987-5934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110617000527 NY Practitioner - Chiropractic 0547441743 Reassigns benefits to 1 organization
Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1235 Forest Hill Rd
C1
Staten Island, NY 10314-6314
Phone (718) 987-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011160NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
JF Chiropractic, PLLC Chiropractor CurrentSince Jan 1, 2019 Accepting new patients
Brokhin Medical, PC Past Accepting new patients
N.Z.S. Medical PC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1851489900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 FOREST HILL RD STE C1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146314",
            "telephone_number": "718-987-5934",
            "fax_number": "718-987-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 FOREST HILL RD # C1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146314",
            "telephone_number": "718-987-2273",
            "fax_number": "718-987-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKOUL",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X011160-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.