Individual provider Active NPI

Nicole M Passanante, PA

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1952563843
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013296 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(718) 226-9158
Fax
(718) 226-6964
NPI assigned
Jul 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P65540 NY
Physician Assistant 363A00000X 013296 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

1 Edgewater St
6TH Floor
Staten Island, NY 10305-4900
Phone (718) 226-4324

Other identifiers 1

IdentifierTypeStateIssuer
03196870MedicaidNY

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
I20090810000005 NY Practitioner - Physician Assistant 5294888251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

129 Sunrise Hwy W
Patchogue, NY 11772-1846
Phone (631) 230-5775

1930 Deer Park Ave
Deer Park, NY 11729-3328
Phone (631) 254-5900

2280 N Ocean Ave
Farmingville, NY 11738-2911
Phone (631) 698-7828

234 W Jericho Tpke
Huntington Station, NY 11746-3628
Phone (631) 423-5400

336 E 86TH St
New York, NY 10028-4615
Phone (212) 772-3627

4724 Nesconset Hwy
Port Jefferson Station, NY 11776-2580
Phone (631) 474-5900

5600 Sunrise Hwy
Sayville, NY 11782-1017
Phone (631) 563-7828

600 Portion Rd
Ronkonkoma, NY 11779-1867
Phone (631) 471-5900

996 Middle Country Rd
Selden, NY 11784-2511
Phone (631) 736-5900

Merit-based Incentive Payment System (MIPS)

Final score
86.33 of 100Reported as group
Quality
82.1
Promoting interoperability
100
Improvement activities
40
Cost
72.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013296NYMDPhysician Assistant
P65540NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
City Medical of Upper East Side, PLLC CurrentSince Sep 4, 2018 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Sep 4, 2018 Accepting new patients

Locations

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

1345 Rxr Plz
Fl 13
Uniondale, NY 11556
Phone (516) 453-0435

Interoperability endpoints

  • Direct secure messaging: nicole.passanante.1@2983.direct.athenahealth.com

Organizations & group practices 3

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": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1952563843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDGEWATER ST",
            "address_2": "6TH FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054900",
            "telephone_number": "718-226-4324",
            "fax_number": "718-226-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9158",
            "fax_number": "718-226-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASSANANTE",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "P65540",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03196870",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.