NPIMap

Individual provider Active NPI

Mylene Manongsong Jumalon, FNP

  • Family Nurse Practitioner
  • East Syracuse, NY
National Provider Identifier
1871897884
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F336192-1 Issued in NY
Practice address
6620 Fly Rd Ste 100
East Syracuse, NY 13057-4281
Phone
(315) 464-4472
Fax
(315) 464-5222
NPI assigned
Jan 5, 2011
Last updated
Jul 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 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 F336192-1 NY Primary

Addresses

Primary practice location

6620 Fly Rd Ste 100
East Syracuse, NY 13057-4281

Mailing address

6620 Fly Rd Ste 200
East Syracuse, NY 13057-4282
Phone (315) 464-5551

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
I20120316000608 NY Practitioner - Nurse Practitioner 0547429185 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adirondack Interventional Physiatry PCGroup PAC ID 1254308463, 7 clinicians

Practice addresses (Care Compare)

4 Feathers Dr
Platsburgh, NY 12901-6461
Phone (518) 324-7246

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.59 of 100Reported as group
Quality
78.3
Promoting interoperability
100
Improvement activities
40
Cost
72.17

Merit-based Incentive Payment System (MIPS)

Final score
91.43 of 100Reported as group
Quality
90.7
Promoting interoperability
100
Improvement activities
40
Cost
80.73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F336192-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Associates PC CurrentSince Mar 8, 2024 Accepting new patients
United Medical Associates, P.C. CurrentSince Mar 8, 2024 Accepting new patients
Upstate Orthopedics, LLP CurrentSince Sep 3, 2024 Accepting new patients
Adirondack Interventional Physiatry PC CurrentSince Sep 1, 2025 Accepting new patients
Upstate Orthopedics, LLP CurrentSince Sep 3, 2024 Accepting new patients
United Health Services Hospitals, Inc. CurrentSince May 24, 2024 Accepting new patients
Surgical Pain Center of the Adirondacks, LLC PastSince Sep 1, 2025 Accepting new patients
Bhupinder Singh Bolla MD PLLC PastSince Jan 19, 2020 Accepting new patients

Locations

208 Township Blvd
Ste 200
Camillus, NY 13031
Phone (315) 464-4472

6620 Fly Rd
Ste 100
East Syracuse, NY 13057
Phone (315) 464-4472

6620 Fly Rd
Ste 200
East Syracuse, NY 13057
Phone (315) 464-4472

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

507 Main St
Johnson City, NY 13790
Phone (607) 763-6075

52 Harrison St
#2
Johnson City, NY 13790
Phone (607) 729-1521

52 Harrison St
Fl 2
Johnson City, NY 13790
Phone (607) 729-1521

4 Feathers Dr
Plattsburgh, NY 12901
Phone (518) 324-5261

85 Plaza Blvd
#102
Plattsburgh, NY 12901
Phone (518) 324-7246

Organizations & group practices 8

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": "1294185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1871897884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 FLY RD STE 200",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574282",
            "telephone_number": "315-464-5551",
            "fax_number": "315-464-5229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 FLY RD STE 100",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574281",
            "telephone_number": "315-464-4472",
            "fax_number": "315-464-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUMALON",
        "first_name": "MYLENE",
        "middle_name": "MANONGSONG",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-05",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F336192-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.