Individual provider Active NPI

Liliana McFetridge, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Jackson Heights, NY
National Provider Identifier
1942477781
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011747 Issued in NY
Practice address
9033 Elmhurst Ave
Jackson Heights, NY 11372-7935
Phone
(718) 457-7000
NPI assigned
May 12, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 011747 NY Primary

Addresses

Primary practice location

9033 Elmhurst Ave
Jackson Heights, NY 11372-7935

Mailing address

9033 Elmhurst Ave
Jackson Heights, NY 11372-7935
Phone (718) 457-7000

Other identifiers 1

IdentifierTypeStateIssuer
011747OtherNYLICENSE #

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
I20170220002708 NY Practitioner - Physician Assistant 0345523221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1200 Brown St
Peekskill, NY 10566-3617

265 Sunrise Hwy
Suite 20
Rockville Centre, NY 11570

265 Sunrise Hwy 20
Rockville Centre, NY 11570-4912

3047 Ave U
Brooklyn, NY 11229

5555 Glenridge Connector
Suite 700
Atlanta, GA 30342-4758

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
011747NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sun River Health Inc. CurrentSince Dec 7, 2015 Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

1037 Main St
Peekskill, NY 10566
Phone (914) 734-8800

Interoperability endpoints

  • Direct secure messaging: liliana.mcfetridge@ghuc.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484265600000",
    "number": "1942477781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9033 ELMHURST AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727935",
            "telephone_number": "718-457-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9033 ELMHURST AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727935",
            "telephone_number": "718-457-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCFETRIDGE",
        "first_name": "LILIANA",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-12",
        "last_updated": "2017-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "011747",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.