Individual provider Active NPI

James M Carroll, RN, BSN

  • Registered Nurse
  • Valley Stream, NY
National Provider Identifier
1942691944
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
670808 Issued in NY
Practice address
13 Cleveland St
Valley Stream, NY 11580-6003
Phone
(516) 823-0739
Fax
(516) 823-1550
NPI assigned
Feb 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 670808 NY Primary

Addresses

Primary practice location

13 Cleveland St
Valley Stream, NY 11580-6003

Mailing address

12 Dongan PL
Apt. 502
New York, NY 10040-1523
Phone (917) 576-8065

Other identifiers 1

IdentifierTypeStateIssuer
670808OtherNYNEW YORK STATE NURSING LICENSE

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
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
670808NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423612800000",
    "number": "1942691944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 DONGAN PL",
            "address_2": "APT. 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100401523",
            "telephone_number": "917-576-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CLEVELAND ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115806003",
            "telephone_number": "516-823-0739",
            "fax_number": "516-823-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JAMES",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "RN, BSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "670808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE NURSING LICENSE",
            "identifier": "670808",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.