Individual provider Active NPI

Jessica Laine, FNP

  • Family Nurse Practitioner
  • Queens Village, NY
National Provider Identifier
1861226706
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F35495801 Issued in NY
Practice address
11317 Colfax St
Queens Village, NY 11429-2218
Phone
(347) 886-3101
NPI assigned
Aug 30, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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 F35495801 NY Primary

Addresses

Primary practice location

11317 Colfax St
Queens Village, NY 11429-2218

Mailing address

11317 Colfax St
Queens Village, NY 11429-2218
Phone (347) 886-3101

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240926004091 NY Practitioner - Nurse Practitioner 8921431594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kings County House Calls NP in Family Health PLLCGroup PAC ID 3971844606, 35 clinicians

Practice addresses (Care Compare)

3709 Flatlands Ave
Brooklyn, NY 11234-3507
Phone (646) 535-1545

Hospital & facility affiliations

  • Girling Health Care of New York Home health agency, Brooklyn, NY, CCN 337243
  • Emerest Home Health Care of Long Island Home health agency, Flushing, NY, CCN 337189
  • Americare Certified Special Services, Inc Chha Home health agency, Brooklyn, NY, CCN 337290
  • Revival Home Health Care Home health agency, Staten Island, NY, CCN 337299

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F35495801NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Laine Medical Supplies LLC CurrentSince Nov 15, 2019 Accepting new patients
Kings County House Calls NP in Family Health PLLC CurrentSince Sep 21, 2024 Accepting new patients

Locations

3709 Flatlands Ave
Brooklyn, NY 11234
Phone (646) 535-1545

Organizations & group practices 2

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 4

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": "1724976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1861226706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11317 COLFAX ST",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292218",
            "telephone_number": "347-886-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11317 COLFAX ST",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292218",
            "telephone_number": "347-886-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAINE",
        "first_name": "JESSICA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-30",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F35495801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queens Village, NY

Sources for this page

Verify at the official NPI Registry.