Individual provider Active NPI

Rebecca Jo Yaeger, LPN

  • Licensed Practical Nurse
  • Horseheads, NY
National Provider Identifier
1861510646
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
132085-1 Issued in NY
Practice address
567 Sing Sing Rd
Horseheads, NY 14845-1140
Phone
(607) 796-0531
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 132085-1 NY Primary

Addresses

Primary practice location

567 Sing Sing Rd
Horseheads, NY 14845-1140

Mailing address

567 Sing Sing Rd
Horseheads, NY 14845-1140
Phone (607) 796-0531

Other identifiers 1

IdentifierTypeStateIssuer
02323568MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
132085-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1861510646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 SING SING RD",
            "city": "HORSEHEADS",
            "state": "NY",
            "postal_code": "148451140",
            "telephone_number": "607-796-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 SING SING RD",
            "city": "HORSEHEADS",
            "state": "NY",
            "postal_code": "148451140",
            "telephone_number": "607-796-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAEGER",
        "first_name": "REBECCA",
        "middle_name": "JO",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "132085-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02323568",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Horseheads, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.