NPIMap

Individual provider Active NPI

Nicole Ferrantelli, PA

  • Surgical Physician Assistant
  • Rockville Centre, NY
National Provider Identifier
1912158809
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
012806 Issued in NY
Practice address
100 Merrick Rd
Suite 128W
Rockville Centre, NY 11570-4800
Phone
(516) 255-9031
NPI assigned
Oct 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 002178 CT
Surgical Physician Assistant 363AS0400X 012806 NY Primary

Addresses

Primary practice location

100 Merrick Rd
Suite 128W
Rockville Centre, NY 11570-4800

Mailing address

100 Merrick Rd
Suite 128W
Rockville Centre, NY 11570-4800
Phone (516) 255-9031

Other identifiers 2

IdentifierTypeStateIssuer
012806OtherNYNY LICENSE
002178OtherCTCT LICENSE

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
I20130411000066 NY Practitioner - Physician Assistant 4587726443 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical Services PCGroup PAC ID 7012016009, 341 clinicians

Practice addresses (Care Compare)

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (516) 705-2689

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6000

50 Route 25a
Smithtown, NY 11787-1348
Phone (631) 862-3000

Hospital & facility affiliations

  • St Catherine of Siena Hospital Hospital, Smithtown, NY, CCN 330401
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002178CTMDProfessional Counselor

Practice roles (3 of 7)

OrganizationSpecialtyStatusNew patients
Neurological Surgery Practice of Long Island PLLC PastSince Jan 1, 1995 Accepting new patients
NSPC Plastics Past Accepting new patients
St Catherine of Siena Medical Center Past Accepting new patients

Networks

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

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1912158809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MERRICK RD",
            "address_2": "SUITE 128W",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704800",
            "telephone_number": "516-255-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MERRICK RD",
            "address_2": "SUITE 128W",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704800",
            "telephone_number": "516-255-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERRANTELLI",
        "first_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-09",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "002178",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "012806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY LICENSE",
            "identifier": "012806",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CT LICENSE",
            "identifier": "002178",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.